To compare outcomes of patients with infective endocarditis (IE) first treated in secondary hospitals and then transferred to reference centres for surgery, to those diagnosed in reference centres, and to evaluate the impact of surgery timing on prognosis.
Analysis of a prospective cohort of patients with active IE admitted to three reference centres between 1996 and 2022 who underwent cardiac surgery in the first month after diagnosis. Multivariable analysis was performed to evaluate the impact of transfer to reference centres and time to surgery on 30-day mortality. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated.
Among 703 patients operated on for IE, 385 (54.8%) were referred cases. All-cause 30-day mortality did not differ significantly between referred patients and those diagnosed at reference centres (102/385 [26.5%] vs 78/385 [24.5%]; p=0.552). Variables independently associated with 30-day mortality in the whole cohort were: diabetes (OR 1.76, [95% CI 1.15-2.69]), chronic kidney disease (OR 1.83, [95% CI 1.08-3.10]), S. aureus (OR 1.88, [95% CI 1.18-2.98]), septic shock (OR 2.76, [95% CI 1.67-4.57]), heart failure (OR 1.41, [95% CI 0.85-2.11]), acute renal failure before surgery (OR 1.76, [95% CI 1.15-2.69]), and the interaction between transfer to reference centres and surgery timing (OR 1.18 [95% CI 1.03-1.35]). Amidst referred patients, time from diagnosis to surgery longer than a week was independently associated with 30-day mortality (OR 2.19 [95% CI 1.30-3.69]; p=0.003).
Among referred patients, surgery performed more than 7 days after diagnosis was associated with two-fold higher 30-day mortality.

Copyright © 2023. Published by Elsevier Ltd.