Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study.
OBJECTIVE
The timing of cardiac surgery for infective endocarditis with ischaemic stroke remains controversial.


METHODS
Using a nationwide inpatient database in Japan, we conducted a retrospective observational study. We identified patients aged 20 years or older with ischaemic stroke on admission who were diagnosed with infective endocarditis and underwent cardiac surgery during the initial hospitalization between July 2010 and March 2013. In-hospital mortality and perioperative complications were compared between the early (≤7 days) and late (>7 days) surgery groups using logistic regression analyses with adjustment for propensity scores and inverse probability of treatment weighting.


RESULTS
We identified 253 patients who underwent cardiac valve surgery for infective endocarditis with ischaemic stroke on admission. In-hospital mortality rates were 8.6 and 9.5% in the early (n = 105) and late (n = 148) surgery groups, respectively. There were no significant differences in the in-hospital mortality between the early and late surgery groups in the propensity score-adjusted model [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.35-2.54] and inverse probability-weighted model (risk difference, -0.82%; 95% CI, -6.43 to 4.84%). The perioperative complication rates were 42.9 and 37.8% in the early and late surgery groups, respectively, and showed no significant differences in the propensity score-adjusted model (OR, 1.11; 95% CI, 0.63-1.97) and inverse probability-weighted model (risk difference, 1.54%; 95% CI, -7.13 to 10.2%).


CONCLUSIONS
Early timing of surgery for infective endocarditis patients with ischaemic stroke was not associated with higher in-hospital mortality or complications after admission. Early timing of surgery may not be contraindicated for infective endocarditis patients with ischaemic stroke.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Kojiro
K
Morita
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Yusuke
Y
Sasabuchi
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Hiroki
H
Matsui
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
Kiyohide
K
Fushimi
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan yasunagah-tky@umin.ac.jp.
Hideo
H
Yasunaga
D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors
Complications; Endocarditis (all infectious agents); Stroke; Surgery