Effect of Publicly Reported Aortic Valve Surgery Outcomes on Valve Surgery in Injection Drug- and Non-Injection Drug-Associated Endocarditis.
cardiac surgery
endocarditis
injection drug use
public reporting
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
27 07 2020
27 07 2020
Historique:
received:
28
05
2019
accepted:
23
08
2019
pubmed:
11
10
2019
medline:
28
4
2021
entrez:
11
10
2019
Statut:
ppublish
Résumé
Injection drug use-associated infective endocarditis (IDU-IE) is rising and valve surgery is frequently indicated. The effect of initiating public outcomes reporting for aortic valve surgery on rates of valve surgery and in-hospital mortality for endocarditis is not known. For an interrupted time series analysis, we used data from the National Inpatient Sample, a representative sample of United States inpatient hospitalizations, from January 2010 to September 2015. We included individuals aged 18-65 with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of endocarditis. We defined IDU-IE using a validated combination of ICD-9 codes. We used segmented logistic regression to assess for changes in valve replacement and in-hospital mortality rates after the public reporting initiation in January 2013. We identified 7322 hospitalizations for IDU-IE and 23 997 for non-IDU-IE in the sample, representing 36 452 national IDU-IE admissions and 119 316 non-IDU admissions, respectively. Following the implementation of public reporting in 2013, relative to baseline trends, the odds of valve replacement decreased by 4.0% per quarter (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99), with no difference by IDU status. The odds of an in-patient death decreased by 2.0% per quarter for both IDU-IE and non-IDU-IE cases following reporting (OR 0.98, 95% CI 0.97-0.99). Initiating public reporting was associated with a significant decrease in valve surgery for all IE cases, regardless of IDU status, and a reduction in-hospital mortality for patients with IE. Patients with IE may have less access to surgery as a consequence of public reporting. To understand how reduced valve surgery impacts overall mortality, future studies should examine the postdischarge mortality rate.
Sections du résumé
BACKGROUND
Injection drug use-associated infective endocarditis (IDU-IE) is rising and valve surgery is frequently indicated. The effect of initiating public outcomes reporting for aortic valve surgery on rates of valve surgery and in-hospital mortality for endocarditis is not known.
METHODS
For an interrupted time series analysis, we used data from the National Inpatient Sample, a representative sample of United States inpatient hospitalizations, from January 2010 to September 2015. We included individuals aged 18-65 with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of endocarditis. We defined IDU-IE using a validated combination of ICD-9 codes. We used segmented logistic regression to assess for changes in valve replacement and in-hospital mortality rates after the public reporting initiation in January 2013.
RESULTS
We identified 7322 hospitalizations for IDU-IE and 23 997 for non-IDU-IE in the sample, representing 36 452 national IDU-IE admissions and 119 316 non-IDU admissions, respectively. Following the implementation of public reporting in 2013, relative to baseline trends, the odds of valve replacement decreased by 4.0% per quarter (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99), with no difference by IDU status. The odds of an in-patient death decreased by 2.0% per quarter for both IDU-IE and non-IDU-IE cases following reporting (OR 0.98, 95% CI 0.97-0.99).
CONCLUSIONS
Initiating public reporting was associated with a significant decrease in valve surgery for all IE cases, regardless of IDU status, and a reduction in-hospital mortality for patients with IE. Patients with IE may have less access to surgery as a consequence of public reporting. To understand how reduced valve surgery impacts overall mortality, future studies should examine the postdischarge mortality rate.
Identifiants
pubmed: 31598642
pii: 5584178
doi: 10.1093/cid/ciz834
pmc: PMC7384313
doi:
Substances chimiques
Pharmaceutical Preparations
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
480-487Subventions
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI052074
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA042168
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Organisme : NIDA NIH HHS
ID : R25 DA013582
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
JAMA Netw Open. 2018 Nov 2;1(7):e185220
pubmed: 30646383
Med Care. 2018 Oct;56(10):e70-e75
pubmed: 29200131
Ann Intern Med. 2018 Sep 4;169(5):335-336
pubmed: 30007032
Ann Thorac Surg. 2014 May;97(5):1486-7
pubmed: 24792246
Health Aff (Millwood). 2016 May 1;35(5):832-7
pubmed: 27140989
PLoS One. 2013;8(3):e60033
pubmed: 23527296
N Engl J Med. 2012 Jun 28;366(26):2466-73
pubmed: 22738096
Ann Intern Med. 2019 Jan 1;170(1):31-40
pubmed: 30508432
JACC Cardiovasc Interv. 2016 Oct 24;9(20):2077-2085
pubmed: 27765301
Chest. 2007 Sep;132(3):1025-35
pubmed: 17873196
BMC Health Serv Res. 2016 Jul 22;16:296
pubmed: 27448999
Ann Thorac Surg. 2016 Jun;101(6):2265-71
pubmed: 26740032
Circulation. 2017 Jul 18;136(3):329-331
pubmed: 28716834
JAMA Cardiol. 2018 Jul 1;3(7):629-634
pubmed: 29801157
Med Care. 2011 Dec;49(12):1118-25
pubmed: 22002641
Clin Infect Dis. 2019 Sep 13;69(7):1120-1129
pubmed: 30590480
Am J Med. 2016 May;129(5):481-5
pubmed: 26597670
Ann Thorac Surg. 2009 Jul;88(1 Suppl):S23-42
pubmed: 19559823
Int J Epidemiol. 2017 Feb 1;46(1):348-355
pubmed: 27283160
JAMA. 2011 Nov 23;306(20):2239-47
pubmed: 22110106
J Clin Pharm Ther. 2002 Aug;27(4):299-309
pubmed: 12174032
J Thorac Cardiovasc Surg. 2017 Jun;153(6):1259-1260
pubmed: 28024806
Top Health Inf Manage. 1997 Feb;17(3):60-71
pubmed: 10165388
J Subst Abuse Treat. 2018 Sep;92:35-39
pubmed: 30032942
J Thorac Cardiovasc Surg. 2016 Sep;152(3):832-841.e1
pubmed: 27068439
Ann Thorac Surg. 2013 Jun;95(6 Suppl):S1-66
pubmed: 23688839
MMWR Morb Mortal Wkly Rep. 2017 Jun 09;66(22):569-573
pubmed: 28594786
Ann Thorac Surg. 2012 Dec;94(6):2166-71
pubmed: 23127768
J Am Coll Cardiol. 2012 May 29;59(22):1968-76
pubmed: 22624837
Circulation. 2010 Mar 2;121(8):1005-13
pubmed: 20159831
Circulation. 1996 Jan 1;93(1):27-33
pubmed: 8616936
Med Care. 2017 Nov;55(11):918-923
pubmed: 28930890
Surg Infect (Larchmt). 2017 Apr;18(3):299-302
pubmed: 28099093
Circulation. 2015 Oct 13;132(15):1435-86
pubmed: 26373316
Open Forum Infect Dis. 2016 Jul 26;3(3):ofw157
pubmed: 27800528
J Thorac Cardiovasc Surg. 2009 Jan;137(1):82-90
pubmed: 19154908
Ann Thorac Surg. 2017 Jan;103(1):18-24
pubmed: 27884412
J Subst Abuse Treat. 2017 Aug;79:1-5
pubmed: 28673521