Outcomes for endocarditis surgery in North America: A simplified risk scoring system
Open accessAbstract
Objective Operation for infective endocarditis is associated with the highest mortality of any valve disease, with overall rates of in-hospital mortality exceeding 20%. The Society of Thoracic Surgeons Adult Cardiac Surgery Database was examined to develop a simple risk scoring system and identify areas for quality improvement.Methods From 2002 through 2008, 19,543 operations were performed for infective endocarditis. Logistic regression analysis related baseline characteristics to both operative mortality and a composite of mortality and major morbidity within 30 days. Points were assigned to each risk factor, and estimated risk was obtained by averaging events for all patients having the same number of points.Results Overall unadjusted mortality was 8.2%, and complications occurred in 53%. Significant preoperative risk factors for mortality (associated points) were as follows: emergency, salvage status, or cardiogenic shock (17), preoperative hemodialysis, renal failure, or creatinine level less than 2.0 (12), preoperative inotropic or balloon pump support (10), active (vs treated) endocarditis (10), multiple valve involvement (9), insulin-dependent diabetes (8), arrhythmia (8), previous cardiac surgery (7), urgent status without cardiogenic shock (6), non-insulin-dependent diabetes (6), hypertension (5), and chronic lung disease (5), with a C statistic of 0.7578 (all P < .001). Risk-adjusted mortality and major morbidity were unchanged over the course of the study. In the entire data set, mortality was better if "any valve" was repaired (odds ratio = 0.76; P = .0023).Conclusions Operative mortality for surgically treated infective endocarditis is substantially lower than reported in-hospital mortality rates for infective endocarditis. The described risk scoring system will inform clinical decision-making in these complex patients.
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Risk stratification models such as the Society of Thoracic Surgeons Endocarditis Score are available to predict morbidity and mortality risks in infective endocarditis patients after valve surgery and to assist in decision making and patient counseling.
“Risk stratification models such as the Society of Thoracic Surgeons Endocarditis Score are available to predict morbidity and mortality risks in IE patients after valve surgery and to assist in decision making and patient counseling.260”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [260]
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- Authors
- Gaca, J. G., Sheng, S., Daneshmand, M. A., O’Brien, S., Rankin, J. S., Brennan, J. M., Hughes, G. C., Glower, D. D., Gammie, J. S., & Smith, P. K.
- Affiliations
- Duke Medical Center (US)
- Society of Thoracic Surgeons (US)
- Vanderbilt University Medical Center (US)
- University of Maryland Medical Center (US)
- Corresponding author
- Gaca, Jeffrey G.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2011-01
- Volume
- 141
- Issue
- 1
- Pages
- 98-106.e2
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W1984975291
- Semantic Scholar
- d15e686020a843e53ac41d27dd8240dd644c0681
- Cited by
- 254
- References
- 22
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 20 · 2023: 13 · 2022: 11 · 2021: 18 · 2020: 30 · 2019: 31 · 2018: 19 · 2017: 22 · 2016: 11 · 2015: 12 · 2014: 20 · 2013: 12 · 2012: 9
- FWCI
- 7.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
- Keywords
- infective endocarditis, cardiac surgery outcomes, risk scoring, postoperative mortality, postoperative morbidity, preoperative risk factors, valve repair, Society of Thoracic Surgeons Adult Cardiac Surgery Database, quality improvement
- MeSH terms
- Aged, Endocarditis, Female, Health Status Indicators, Cardiac Surgical Procedures, Humans, Male, Middle Aged, North America, Outcome and Process Assessment, Health Care, Retrospective Studies, Risk Factors, Logistic Models, Odds Ratio, Treatment Outcome, Hospital Mortality, Risk Assessment, Patient Selection, Quality Indicators, Health Care, Databases as Topic
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