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- Title
Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data.
- Authors
Schranz, Asher J.; Fleischauer, Aaron; Chu, Vivian H.; Wu, Li-Tzy; Rosen, David L.
- Abstract
<bold>Background: </bold>Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown.<bold>Objective: </bold>To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges.<bold>Design: </bold>10-year analysis of a statewide hospital discharge database.<bold>Setting: </bold>North Carolina hospitals, 2007 to 2017.<bold>Patients: </bold>All patients aged 18 years or older hospitalized for IE.<bold>Measurements: </bold>Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges.<bold>Results: </bold>Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million.<bold>Limitation: </bold>Reliance on administrative data and billing codes.<bold>Conclusion: </bold>DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE.<bold>Primary Funding Source: </bold>National Institutes of Health.
- Subjects
NORTH Carolina; DRUG utilization; INFECTIVE endocarditis; HEART valve surgery; HOSPITAL care; LENGTH of stay in hospitals; ENDOCARDITIS; PROSTHETIC heart valves; HEART valve diseases; HOSPITAL charges; RESEARCH funding; SUBSTANCE abuse; RETROSPECTIVE studies; DISEASE complications
- Publication
Annals of Internal Medicine, 2019, Vol 170, Issue 1, p31
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M18-2124