title: Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis.
abstract: Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis.
  
  
  
  PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed.
  
  
  
  A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts.
  
  
  
  The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.
authors: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Mahesh
authors: 0000-0001-5894-7406
authors: M
authors: Anantha Narayanan
authors: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Toufik
authors: T
authors: Mahfood Haddad
authors: Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, Nebraska, USA.
authors: Andre C
authors: AC
authors: Kalil
authors: Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Arun
authors: A
authors: Kanmanthareddy
authors: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Rakesh M
authors: RM
authors: Suri
authors: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: George
authors: G
authors: Mansour
authors: School of Pharmacy & Health Professions and School of Medicine, Creighton University, Omaha, Nebraska, USA.
authors: Christopher J
authors: CJ
authors: Destache
authors: University of Texas Southwestern at Dallas, Dallas, Texas, USA.
authors: Janani
authors: J
authors: Baskaran
authors: Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Aryan N
authors: AN
authors: Mooss
authors: Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Tammy
authors: T
authors: Wichman
authors: Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Lee
authors: L
authors: Morrow
authors: Division of Infectious Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Renuga
authors: R
authors: Vivekanandan
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004696:Endocarditis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D057216:Propensity Score; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents