Abstract 2867: Delays to Surgery in Infective Endocarditis
Introduction The benefits of surgery in patients with infective endocarditis (IE) are disputed, despite published guidelines describing clear indications for urgent surgery in this condition (eg. severe heart failure, complicated prosthetic valve infection, intracardiac abscess or fistula formation). We hypothesized that the apparently inconsistent benefits may relate to preventable delays between diagnosis and surgery. We investigated the incidence and causes of delays in surgery for patients with IE.
Methods We studied 41 consecutive patients with left-sided IE who had an accepted indication for urgent surgery. Data was collected regarding the indications for surgery, the timing, and reasons for delays in surgery. Associations between these factors and all-cause mortality at one year were examined.
Results Indications for urgent surgery included: NYHA FC III/IV heart failure due to severe regurgitation in 27 patients (66%); fistula or abscess formation in ten patients (24%); and prosthetic valve dehiscence or obstruction in four patients (10%). The median interval between hospital admission and surgery was 14 days (IQR 9–24), and the median interval between the identification of a surgical indication and actual surgery was 4 days (IQR 2–11). Twelve patients (12/41= 29%) were identified as having an inappropriate delay of more than 7 days between identification of the surgical indication and surgery. The most common reason for inappropriate delay was non-recognition of the prognostic significance of serious conditions (severe heart failure n=5, complicated prosthetic valve infection n=3, and intracardiac fistula or abscess n=2). Other reasons for delaying surgery included recent stroke and patient preference. Mortality at one year tended to be higher in patients undergoing delayed surgery (42%) than in patients undergoing surgery expediently (28%) (p=0.47, chi-square test).
Conclusions Delays in surgery are common, frequently preventable, and highlight differences between real-world practice and published guidelines. Such delays may undermine the prognostic benefit of surgery in patients with IE.