Outcomes After Valvular Surgery for Infective Endocarditis in People Who Abuse Opioids

Background: A limited number of studies have analyzed outcomes following surgery for infective endocarditis (IE) in patients with opioid misuse. Therefore, this study aimed to assess post-surgery survival rates for IE in opioid users compared to those with community-acquired IE (CA-IE). The secondary outcomes included mortality, readmission, and reinfection rates during mid-term follow-up. Methods: Our retrospective study included 126 patients with IE who underwent surgical intervention from June 2007 to September 2024. Of the 126 patients, 75 were opioid abusers, while the remaining 51 were diagnosed with CA-IE. IE was diagnosed using the modified Duke criteria. To confirm malnutrition as a risk factor of mortality and morbidity MN after cardiac surgery, the patients were evaluated by an experienced dietitian preoperatively. Transthoracic echocardiography, with or without transesophageal echocardiography (TOE), was conducted to assess vegetation growth, valve dysfunction, and myocardial function. The key endpoint was mortality occurring within 30 days post-surgery. The secondary endpoints were the rates of IE recurrence, reoperation, and mortality during the follow-up period. Multivariable regression was employed to assess the relationship between mortality and opioid addiction over the follow-up period. Results: Over 65% of patients (n = 49) reported a history of intravenous heroin use, while 16 patients (21.3%) were identified as cocaine users, with various methods of admission recorded, including snorting and intravenous injection. Of the remaining 10 patients (13.3%), all had a history of using oral methamphetamine and dextroamphetamine, both of which are psychostimulant drugs, in combination with injected substances. The mean drug use duration was 9.4 years, with a standard deviation of 3.2 years, and a range of 3 to 11 years. In-hospital mortality rates were comparable between the two groups (three patients with opioid abuse (6.6%) vs. five patients with CA-IE (5.8%); p = 0.685). Isolated right-sided IE was more prevalent in individuals with opioid addiction compared to community-acquired IE (45.3% vs. 17.6%; p = 0.012), followed by mitral valve IE (14% vs. 21.5%; p = 0.004). The patients who abused opioids were significantly younger and exhibited fewer comorbidities. The mean intensive care unit duration for opioid-abusing IE patients was considerably greater than for non-abusing patients (3.9 days vs. 2.1 days; p = 0.01). The median duration of hospitalization was significantly longer for opioid users than for patients with CA-IE (49.9 ± 19.4 days vs. 27.1 ± 12.2 days; p = 0.022). Multivariate Cox regression analysis indicated that opioid abuse (hazard ratio (HR): 2.012, 95% confidence interval (CI): 1.96–4.56; p = 0.002), urgent surgery (HR: 1.96, 95% CI: 1.41–5.12; p = 0.024), congestive heart failure (HR: 2.58, 95% CI: 1.94–5.07; p = 0.032), and redo valvular surgery (HR: 1.78, 95% CI: 1.29–6.04; p = 0.002) were independent predictors of mortality. The median follow-up duration for individuals with opioid abuse and CA-IE was 60.7 ± 23.3 months and 59.4 ± 24.9 months, respectively. The incidence of readmission was more prevalent among patients who abused opioids than among those who did not. Nine opioid users with IE (12.8%) were readmitted due to a new episode of IE, whereas the readmission rate in the CA-IE group was 4% (n = 2 patients) due to recurrence of IE (odds ratio (OR): 3.96; p = 0.004). Reoperation rates in patients with a tendency to misuse opioids were considerably elevated compared to those with CA-IE (8.5% vs. 4%; OR: 4.12; p = 0.01). Conclusion: Mortality rates following surgery for IE were markedly elevated in patients with a history of opioid abuse throughout mid-term follow-up relative to those with CA-IE. Opioid users with IE had elevated readmission and reoperation rates compared to patients with community-acquired IE. Intravenous opioid administration, revision surgery, congestive heart failure, and emergency surgery were independent mortality risk factors. Prospective randomized studies are required to investigate risk factors for mortality, comorbidities, and readmission following a new episode of IE during the follow-up period.