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BMC Medicine
Published in: BMC Medicine 1/2024

Open Access 01-12-2024 | Endocarditis | Research article

Healthcare exposures and associated risk of endocarditis after open-heart cardiac valve surgery

Authors: Timothy N. Kwan, David Brieger, Vincent Chow, Arnold Chin Tse Ng, Gemma Kwan, Karice Hyun, Raymond Sy, Leonard Kritharides, Austin Chin Chwan Ng

Published in: BMC Medicine | Issue 1/2024

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Abstract

Background

Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE).

Methods

In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis.

Results

In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3–8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1–5.4), coronary angiogram (HR = 4.0, 95% CI 2.3–7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3–4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8–8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5–4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1–1.5, p = 0.002).

Conclusions

The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.
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Metadata
Title
Healthcare exposures and associated risk of endocarditis after open-heart cardiac valve surgery
Authors
Timothy N. Kwan
David Brieger
Vincent Chow
Arnold Chin Tse Ng
Gemma Kwan
Karice Hyun
Raymond Sy
Leonard Kritharides
Austin Chin Chwan Ng
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2024
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-024-03279-1

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