title: Injection Drug Use and Outcomes After Surgical Intervention for Infective Endocarditis.
abstract: BACKGROUND
  Infective endocarditis (IE) requiring surgical intervention in patients who actively inject drugs poses treatment challenges. Decisions regarding the need for operation are affected by concern for relapse of IE from ongoing injection drug use (IDU). The purpose of this study was to evaluate the effect of active IDU on outcomes after operation for IE.
  
  
  METHODS
  All patients with IE surgically treated at Cleveland Clinic from July 1, 2007 to July 1, 2012 were identified from the Cleveland Clinic Infective Endocarditis Registry and the Cardiovascular Information Registry. Of 536 patients operated on for IE during the study period, 41 (8%) actively injected drugs. The primary outcome of the study was death or reoperation for IE.
  
  
  RESULTS
  Patients who injected drugs had poorer survival free of reoperation, and the risk of events varied with time. In a multivariable Cox proportional hazards model, using time-dependent covariates, IDU was associated with a higher hazard of death or reoperation between 90 and 180 days (hazard ratio [HR], 9.8; 95% confidence interval [CI], 2.7-35.3) but not before 90 days (HR, 0.38; 95% CI, 0.05-3.1) or after 180 days (HR, 1.8; 95% CI, 0.8-3.8). Among patients who injected drugs, reoperation and death contributed equally to the outcome, whereas among patients who did not inject drugs, reoperation for IE was far less common.
  
  
  CONCLUSIONS
  Between 3 and 6 months after operation for IE, patients who inject drugs have a hazard of death or reoperation that is about 10 times that of patients who do not inject drugs. Before and after, the HRs are much smaller and not statistically significant.
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio. Electronic address: shrestn@ccf.org.
authors.forename: Nabin K
authors.initials: NK
authors.lastname: Shrestha
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jue
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Syed T
authors.initials: ST
authors.lastname: Hussain
authors.affiliation: Department of Psychiatry, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Jerry
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Gosta B
authors.initials: GB
authors.lastname: Pettersson
authors.affiliation: Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D004696:Endocarditis / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome