Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality—a nationwide study
Posted on 2022-07-31 - 15:05
Abstract Background Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist. Methods We included patients with first-time IE (1999–2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999–2003, 2004–2008, 2009–2013, 2014–2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression. Results We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999–2003 to 2014–2018. Compared with 1999–2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96–1.35), OR = 1.20 (95% CI: 1.02–1.42), and OR = 1.10 (95% CI: 0.93–1.29) in 2004–2008, 2009–2013, and 2014–2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999–2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65–1.41), HR = 0.43 (95% CI: 0.28–0.67), and HR = 0.55 (95% CI 0.37–0.83) in 2004–2008, 2009–2013, and 2014–2018, respectively. Conclusions On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.
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Jensen, Andreas Dalsgaard; Østergaard, Lauge; Petersen, Jeppe K.; Graversen, Peter; Butt, Jawad H.; Bundgaard, Henning; et al. (2022). Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality—a nationwide study. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.6125440.v1
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AUTHORS (18)
AJ
Andreas Dalsgaard Jensen
LØ
Lauge Østergaard
JP
Jeppe K. Petersen
PG
Peter Graversen
JB
Jawad H. Butt
HB
Henning Bundgaard
CM
Claus Moser
MS
Morten H. Smerup
IM
Ivy S. Modrau
KI
Kasper Iversen
NB
Niels E. Bruun
CT
Christian Torp-Pedersen
GG
Gunnar Gislason
AW
Andrew Wang
SR
Sigurdur Ragnarsson
JP
Jonas A. Povlsen
LK
Lars Køber
EF
Emil L. Fosbøl