Drug Use and Postoperative Mortality Following Valve Surgery for Infective Endocarditis: A Systematic Review and Meta-analysis

Clin Infect Dis. 2019 Sep 13;69(7):1120-1129. doi: 10.1093/cid/ciy1064.


Background: Infective endocarditis (IE) often requires surgical intervention. An increasingly common cause of IE is injection drug use (IDU-IE). There is conflicting evidence on whether postoperative mortality differs between people with IDU-IE and people with IE from etiologies other than injection drug use (non-IDU-IE). In this manuscript, we compare short-term postoperative mortality in IDU-IE vs non-IDU-IE through systematic review and meta-analysis.

Methods: The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Publication databases were queried for key terms included in articles up to September 2017. Randomized controlled trials, prospective cohorts, or retrospective cohorts that reported on 30-day mortality or in-hospital/operative mortality following valve surgery and that compared outcomes between IDU-IE and non-IDU-IE were included.

Results: Thirteen studies with 1593 patients (n = 341 [21.4%] IDU-IE) were included in the meta-analysis. IDU-IE patients more frequently had tricuspid valve infection, Staphylococcus infection, and heart failure before surgery. Meta-analysis revealed no statistically significant difference in 30-day postsurgical mortality or in-hospital mortality between the 2 groups.

Conclusions: Despite differing preoperative clinical characteristics, early postoperative mortality does not differ between IDU-IE and non-IDU-IE patients who undergo valve surgery. Future research on long-term outcomes following valve replacement is needed to identify opportunities for improved healthcare delivery with IDU-IE.

Keywords: endocarditis; injection drug use; postoperative mortality; valve surgery.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Cause of Death
  • Endocarditis / etiology*
  • Endocarditis / mortality*
  • Endocarditis, Bacterial / etiology
  • Endocarditis, Bacterial / mortality
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Hospital Mortality
  • Humans
  • Male
  • Mortality
  • Odds Ratio
  • Postoperative Complications*
  • Substance Abuse, Intravenous / complications
  • Substance-Related Disorders / complications*
  • Time Factors