Impact of Substance Use Disorder on Midterm Mortality After Valve Surgery for Endocarditis
| Autor: | Alysse G. Wurcel, Alice M. Tang, Griffin Boll, Patrick J. Warner, Kenneth G. Warner, Deirdre Burke, Rani Khetarpal |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Substance-Related Disorders medicine.medical_treatment Heart Valve Diseases 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Postoperative Complications Valve replacement mental disorders medicine Endocarditis Humans Cardiac Surgical Procedures Aged Retrospective Studies business.industry Medical record Hazard ratio Retrospective cohort study Middle Aged medicine.disease Heart Valves Cardiac surgery Survival Rate Treatment Outcome 030228 respiratory system Massachusetts Infective endocarditis Cohort Emergency medicine Surgery Female Morbidity Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | The Annals of thoracic surgery. 109(5) |
| ISSN: | 1552-6259 |
| Popis: | Fueled by the burgeoning opioid epidemic, valve surgeries for substance use disorder-related infective endocarditis (SUD-IE) are increasing. The impact of substance use disorder on postvalve replacement morbidity needs further investigation.We queried The Society of Thoracic Surgeons Adult Cardiac Surgery Database for all valve surgeries for infective endocarditis at Tufts Medical Center (2002-2016) and collected demographic and disease-related data, including timing of mortality subclassified as short-term (6 months including operative), midterm (6 months to 5 years), and extended-term (5 years). Patients with documentation of illicit drug use before the operation were considered to have SUD-IE. Deaths were confirmed through review of medical record and matching with the Massachusetts Vital Statistics Database. We performed univariate and multivariate proportional hazard regressions examining the impact of substance use disorder mortality in people who received a valve replacement.In the cohort of 228 patients, 80 (35%) had SUD-IE. Eight-six people (38%) died, and overall mortality was higher in people with SUD-IE compared with non-SUD-IE (48% vs 32%, P = .025). SUD-IE was associated with a higher risk of overall mortality (adjusted hazard ratio, 2.41; 95% confidence interval, 1.38-4.20; P = .002). Although the difference between short-term or extended-term mortality was not significant, SUD-IE was associated with increased frequency of midterm mortality (53% vs 31%, P = .003).Our data reflect high rates of postvalve surgery morbidity and mortality in people with SUD-IE at a tertiary care center. The midterm postoperative period is a vulnerable period for people with SUD-IE worthy of further investigation. |
| Databáze: | OpenAIRE |
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