Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality—a nationwide study

• Published in: BMC cardiovascular disorders 2022-07, Vol.22 (1), p.1-338, Article 338
• Main Authors: Jensen, Andreas Dalsgaard, Østergaard, Lauge, Petersen, Jeppe K, Graversen, Peter, Butt, Jawad H, Bundgaard, Henning, Moser, Claus, Smerup, Morten H, Modrau, Ivy S, Iversen, Kasper, Bruun, Niels E, Torp-Pedersen, Christian, Gislason, Gunnar, Wang, Andrew, Ragnarsson, Sigurdur, Povlsen, Jonas A, Kaber, Lars, Fosbal, Emil L
• Format: Article
• Language: English
• Subjects: Age groups; Cardiac valve surgery; Care and treatment; Cohort analysis; Diagnosis; Drug therapy; Electronic records; Emigration; Endocarditis; Epidemiology; Heart failure; Heart surgery; Heart valve replacement; Hemodialysis; Hospitals; Infectious diseases; Infective endocarditis; Kidney diseases; Liver diseases; Methods; Mortality; Patient outcomes; Patients; Population; Prostheses; Risk factors; Software; Surgery; Temporal trend; Trends
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02761-z

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 [less than or equai to] 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. Keywords: Infective endocarditis, Epidemiology, Temporal trend, Cardiac valve surgery