| Abstract: |
Background Patients who undergo cardiac surgery for drug use-associated infective endocarditis (DUA-IE) have high rates of readmissions for recurrent endocarditis, substance use disorder (SUD), and septicemia. Our primary objective was to assess whether exposure to an addiction consult team (ACT) was associated with reduced readmissions in this population. Methods This single-center retrospective analysis identified patients who underwent cardiac surgery for DUA-IE between 1/2012-9/2022 using the Society for Thoracic Surgeons database, and compared the cumulative incidence of readmissions at 1, 3, 6, and 12 months among those cared for before and after the implementation of an ACT in 9/2017, accounting for competing risk of mortality and adjusted for measured confounders using inverse probability of treatment weighting. Results The 58 patients (35 pre-ACT and 23 post-ACT) were young (36.4 +/- 7.7 years) and predominantly White (53.4%) and male (70.7%). The post-ACT cohort had a significantly lower risk of readmission at 1 month (adjusted risk difference [RD] -23.8% [95% CI -94.4%, -8.3%], P = 0.005) and 3 months (RD -34.1% [-55.1%, -13.1%], P = 0.005), but not at 6 or 12 months. In a sensitivity analysis, the post-ACT cohort also had significantly lower risk of readmissions for SUD complications at 3 months. Discussion and Conclusion ACT exposure was associated with a lower risk of short-term readmission among patients with surgically managed DUA-IE, possibly due to a reduction in SUD-related complications. Additional studies are needed to replicate these findings and to identify ways to sustain the potential benefits of ACTs over the longer term. © 2024 American Society of Addiction Medicine. |
| Keywords: |
adult; middle aged; retrospective studies; postoperative period; follow up; sensitivity analysis; cohort analysis; retrospective study; patient care team; hospitalization; preoperative period; referral and consultation; surgery; hospital discharge; drug dependence; hospital readmission; methadone; substance-related disorders; observational study; thorax surgery; health care planning; patient referral; heart surgery; naloxone; opiate addiction; cumulative incidence; thoracic surgery; infective endocarditis; endocarditis; patient readmission; humans; human; male; female; article; cardiac surgical procedures; mortality risk; key words/abbreviations; act, addiction consult team; addiction medicine; dua-ie, drug use associated-infective endocarditis; emr, electronic medical record; ie, infectious endocarditis; moud, medications for opioid use disorder; sts, society for thoracic surgeons; sud, substance use disorder; addiction consult team; all cause readmission; drug use associated infective endocarditis
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