title: Valve surgery for infective endocarditis is associated with high hospital charges.
abstract: OBJECTIVE
  Half of all patients with infective endocarditis (IE) will require early surgical intervention, and another 40% will eventually undergo surgical treatment for their disease. Although the surgical management of IE is effective, the financial impact of the disease has never been assessed.
  
  
  METHODS
  All patients who underwent valve surgery for native valve IE at the present authors' institution over a 10-year period (1996-2006) were reviewed retrospectively. Hospital charges were identified and adjusted to reflect US$ in 2006. A logistic regression analysis was performed to identify factors affecting charges and the patients' length of stay (LOS).
  
  
  RESULTS
  A total of 369 patients (252 males, 117 females; mean age 53 +/- 15 years) underwent surgery for IE. Of these patients, 121 (33%) had preoperative renal failure and 70 (20%) were intravenous drug users. In addition, 159 patients (43%) had aortic IE, 112 (30%) had mitral IE, and 45 (12%) had both aortic and mitral valve IE. Right- and left-sided IE was identified in 42 patients (11%), and 11 (3%) had isolated right-sided IE. The median hospital charges were US$ 60,072 (interquartile range (IQR) US$ 39,386-103,960), with a median LOS of 15 days (IQR 9-29 days). Both, hospital charges and LOS were higher for patients undergoing emergent operations, or those with active IE (p < 0.001). The 30-day mortality was 2.7%. Regression analyses showed preoperative renal failure (p = 0.007), intraoperative transfusion (p = 0.028) and postoperative gastrointestinal complications (p < 0.001), renal failure (p = 0.012), heart block (p < 0.001), in-hospital mortality (p < 0.001), and patients undergoing emergent procedures (p < 0.001), or with active infection (p < 0.001) to be associated with significantly increased hospital charges. Factors that significantly affected LOS were other non-white race (p = 0.039), postoperative gastrointestinal complications (p = 0.001), stroke (p = 0.014), heart block (p < 0.001), and patients undergoing emergent procedures (p < 0.001) or with active infection (p < 0.001).
  
  
  CONCLUSIONS
  The present series was among the largest to include patients with IE, and the first in which risk factors were assessed for increased hospital charges and resource utilization following surgery for endocarditis. Operations for IE are associated with a significant financial burden to the healthcare system, despite a relatively low percentage of complications. Patients with significant preoperative comorbidities, those with postoperative complications, and those who underwent emergent procedures or who had active IE, were associated with a prolonged LOS and increased hospital charges.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Kemp
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: George
authors.forename: Maurice A
authors.initials: MA
authors.lastname: Smith
authors.forename: Nishant D
authors.initials: ND
authors.lastname: Patel
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D004696:Endocarditis / Q000191:economics* / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics*; D006351:Heart Valves / Q000601:surgery; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies