In patients with infective endocarditis (IE) referred to a referral center, late surgery (>7 days after diagnosis) was associated with a twofold increase in 30-day mortality.
This study aimed to compare the outcomes of surgically treated patients with IE who were initially treated in a non-reference center and then referred to a reference center for surgery, versus patients diagnosed and treated in reference centers. The impact of the timing of surgery on prognosis was also assessed. This involved an analysis of a prospective cohort of patients with active IE, admitted to 3 Spanish referral centers between 1996 and 2022, who underwent cardiac surgery in the first month after diagnosis.
Of the 703 patients who underwent surgery, 54.8% were referred. The 30-day mortality (all causes) did not differ significantly between referred patients and those diagnosed in referral centers (26.5% versus 24.5%; p = 0.552). Variables independently associated with 30-day mortality in the entire cohort were diabetes (OR 1.76; 95% CI 1.15-2.69), chronic kidney disease (OR 1.83; 95% CI 1.08 -3.10), Staphylococcus aureus (OR 1.88; 95% CI 1.18-2.98), septic shock (OR 2.76; 95% CI 1.67-4.57), heart failure ( OR 1.41; 95% CI 0.85-2.11), acute renal failure before surgery (OR 1.76; 95% CI 1.15-2.69) and the interaction between referral to a reference center and the timing of surgery (OR 1.18; 95% CI 1.03-1.35). Among referred patients, a time between diagnosis and surgery longer than one week was independently associated with 30-day mortality (OR 2.19; 95% CI 1.30-3.69; p = 0.003).
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2023-12-19 09:58:54
#Impact #referral #reference #center #timing #surgery #infective #endocarditis #MedNet
