Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017 A Study of Statewide Discharge Data
Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017 A Study of Statewide Discharge Data
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DOI：
10.7326/m18-2124
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发表时间：
2019-01-01
影响因子：
39.2
通讯作者：
Rosen, David L.
中科院分区：
文献类型：
--
作者：
Schranz, Asher J.;Fleischauer, Aaron;Rosen, David L.
背景：由于阿片类药物的流行，吸毒相关的感染性心内膜炎（DUA-IE）正在增加。感染性心内膜炎可能需要进行瓣膜手术，但 DUA-IE 的手术治疗引起了争议，其使用范围尚不清楚。目的：研究 DUA-IE 的住院趋势、手术住院比例、患者特征、住院时间和费用。设计：全州出院数据库的 10 年分析。背景：北卡罗来纳州医院，2007 年至 2017 年。患者：所有 18 岁或以上住院的患者IE.测量：所有 IE 入院和 IE 因瓣膜手术住院的年度趋势，按患者的药物使用状况分层。 DUA-IE 手术住院的特征，包括患者人口学特征、住院时间、处置和费用。结果：在 22 825 例 IE 住院患者中，2602 例 (11%) 因 DUA-IE 住院。 1655 例 IE 住院患者 (7%) 接受了瓣膜手术，其中 285 例 (17%) 因 DUA-IE 住院。每年每 10 万人中 DUA-IE 住院人数从 0.92 人增加到 10.95 人，因手术而住院的 DUA-IE 人从 0.10 人增加到 1.38 人。去年，42% 的 IE 瓣膜手术是在 DUA-IE 患者中进行的。与其他患有 IE 的手术患者相比，患有 DUA-IE 的患者更年轻（中位年龄 33 岁 vs. 56 岁），女性（47% vs. 33%）和白人（89% vs. 63%）更常见，并且主要通过医疗补助（38%）或未投保（35%）。 DUA-IE 的住院时间较长（中位时间为 27 天 vs. 17 天），中位费用较高（250 994 美元 vs. 198 764 美元）。 282 例 DUA-IE 住院费用超过 7800 万美元。局限性：依赖管理数据和计费代码。结论：DUA-IE 住院和瓣膜手术增加了 12 倍以上，所有 IE 瓣膜手术的近一半是在 DUA-IE 患者中进行的。 DUA-IE 患者的激增正在重塑有效治疗 IE 所需的医疗保健资源的范围、类型和融资。主要资金来源：美国国立卫生研究院。
Background: 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.Objective: To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges.Design: 10-year analysis of a statewide hospital discharge database.Setting: North Carolina hospitals, 2007 to 2017.Patients: All patients aged 18 years or older hospitalized for IE.Measurements: 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.Results: 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.Limitation: Reliance on administrative data and billing codes.Conclusion: 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.Primary Funding Source: National Institutes of Health.