Impact of hospital volume of valve operations on the utilization and outcomes of surgery for patients with infective endocarditis

Eur Heart J Acute Cardiovasc Care. 2022 Feb 8;11(2):102-110. doi: 10.1093/ehjacc/zuab116.


Aims: Valve surgery is indicated and can be life-saving in patients with infective endocarditis (IE). We evaluated the impact of hospital valvular surgery volume on utilization and outcomes of surgery for IE.

Methods and results: National Inpatient Sample (NIS) database was used for IE hospitalizations from 2008 to 2015. Hospitals were divided into quartiles based on valve surgery volume with quartile 1 (Q1) indicating lowest volume and quartile 4 (Q4) highest volume. Primary outcome was utilization of valve surgery in patients hospitalized with IE and secondary outcomes were in-hospital mortality and length of stay for IE patients undergoing valve surgery. Volume-outcome relationship was analysed both as categorical (quartiles) and continuous variable (restricted cubic splines). A total of 36 471 hospitalizations for IE were identified using the NIS database from 2008 to 2015 of which 17.33% underwent any valve surgery. Utilization rates of valve surgery for IE were significantly higher in Q4 hospitals (Q1: 6.73%; Q2: 10.39%; Q3: 14.91%; Q4: 2321%). Amongst the admissions for IE endocarditis undergoing valve surgery, there was no significant difference in in-hospital mortality when analysed as a categorical variable (as quartiles). However, when analysed as a continuous variable we note significant variation in outcomes across the Q4 hospitals, with highest volume centres having reduced mortality rates and length of stay.

Conclusion: Hospital valvular surgery volume has direct impact on utilization and outcomes of surgery for IE. Given rising rates of IE and ongoing intravenous drug pandemic, there is need for regionalization of care for IE patients and development of 'endocarditis centres of excellence' for improved patient outcomes.

Keywords: Valve surgery; Volume–outcome; Infective endocarditis.

MeSH terms

  • Endocarditis* / epidemiology
  • Endocarditis* / surgery
  • Endocarditis, Bacterial*
  • Hospital Mortality
  • Hospitalization
  • Hospitals
  • Humans
  • Retrospective Studies