Abstract 5837: The Timing of Surgery Influences Mortality and Morbidity in Adults with Severe Complicated Infective Endocarditis: A Propensity Analysis
Uncertainties exist in patients who could benefit from very early surgical management. We sought to determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE). In 291 consecutive patients (aged 57± 16 years) with definite IE operated on during the active phase, we analyzed the impact of surgery performed within the first week of antimicrobial therapy (≤1st week surgery) on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD). Propensity score (PS) analyses were used to control for bias in treatment assignment. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a significant reduced 6-month mortality only in the quintile of patients with most likelihood for undergoing this early surgical management (10.5% versus 33.3%; adjusted OR, 0.16; 95% CI, 0.03 to 0.82, p= 0.03). Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infection, and have more than one of the three major indications for surgery (75% of cases). Besides, ≤1st week surgery was associated with an increase of relapses or PVD in the whole cohort (15.8% versus 3.6%; adjusted OR, 3.4; 95% CI, 1.24 to 9.60, p= 0.02). Surgery performed within the 1st week of antimicrobial therapy was associated with reduced 6-month mortality in a subgroup of relatively young patients with S aureus IE and more than one major indication for surgery. However a greater risk of relapses and PVD should be expected when surgery is performed very early.