Key result
Injection drug use-associated infective endocarditis is linked to lower index mortality but similar 30-day readmissions.
Why the study?
Does injection drug use affect clinical outcomes and readmissions in patients hospitalized for infective endocarditis?
Observational (n=123,776)
Yes
Does injection drug use affect clinical outcomes and readmissions in patients hospitalized for infective endocarditis?
Absolute Event Rate: 23.8% vs 22.9%
p-value: p=0.077
Injection drug use-associated infective endocarditis is rising in incidence and presents unique management challenges, characterized by lower index mortality but higher rates of specific readmissions for endocarditis, septicemia, and drug abuse.
BACKGROUND Rising rates of hospitalization for infective endocarditis (IE) have been increasingly tied to rising injection drug use (IDU) associated with the opioid epidemic. OBJECTIVES This study analyzed recent trends in IDU-IE hospitalization and characterized outcomes and readmissions for IDU-IE patients. METHODS The authors evaluated the National Readmissions Database (NRD) for IE cases between January 2010 and September 2015. Patients were stratified by IDU status and surgical versus medical management. Primary outcome was 30-day readmission and cause, with secondary outcomes including mortality, length of stay (LOS), adjusted costs, and 180-day readmission. The Kruskal-Wallis and chi-square tests were used to analyze baseline differences by IDU status. Multivariable regressions were used to analyze mortality, readmissions, LOS, and adjusted costs. RESULTS The survey-weighted sample contained 96,344 (77.8%) non-IDU-IE and 27,432 (22.2%) IDU-IE cases. IDU-IE increased from 15.3% to 29.1% of IE cases between 2010 and 2015 (p < 0.001). At index hospitalization, IDU-IE was associated with reduced mortality (6.8% vs. 9.6%; p < 0.001) but not 30-day readmission (23.8% vs. 22.9%; p = 0.077) relative to non-IDU-IE. Medically managed IDU-IE patients had higher LOS (β = 1.36 days; 95% confidence interval [CI]: 0.71 to 2.01), reduced costs (β = -$4,427; 95% CI: -$7,093 to -$1,761), and increased readmission for endocarditis (18.1% vs. 5.6%; p < 0.001), septicemia (14.0% vs. 7.3%; p < 0.001), and drug abuse (4.3% vs. 0.7%; p < 0.001) compared with medically managed non-IDU-IE. Surgically managed IDU-IE patients had increased LOS (β = 4.26 days; 95% CI: 2.73 to 5.80) and readmission for septicemia (15.6% vs. 5.2%; p < 0.001) and drug abuse (7.3% vs. 0.9%; p < 0.001) compared with non-IDU-IE. CONCLUSIONS The incidence of IDU-IE continues to rise nationally. Given the increased readmission for endocarditis, septicemia, and drug abuse, IDU-IE presents a serious challenge to current management of IE.
No takes yet. Share an insight, caveat, or question.
Rudasill et al. (2019) conducted an observational in Infective endocarditis (n=123,776). Injection drug use vs. Non-injection drug use was evaluated on 30-day readmission (p=0.077). Injection drug use in infective endocarditis was associated with lower index mortality (6.8% vs 9.6%) but similar 30-day readmission (23.8% vs 22.9%; P=0.077) compared with non-injection drug use.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: