Risk Factor Analysis for 30-Day Mortality After Surgery for Infective Endocarditis

Infective endocarditis (IE) remains one of the most challenging diseases of modern times. It is associated with high mortality and morbidity despite significant improvements in diagnostic and surgical skills, and antibiotic pretreatment.  Every study contributes to the knowledge of this often-lethal disease, but one of the ongoing challenges is determining which patients are likely to survive and how survival in general can be improved. Currently, between 52.9 percent and 58.9 percent of patients with IE have a theoretical indication for surgery. However, valve surgery is only performed in approximately 40 percent of cases. Several scoring systems, such as EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS, have been evaluated to assess the operability of a given patient, but the utility of these scores remains questionable.  While 30-day mortality is considered an outdated tool for evaluating surgical quality, and abandoning this concept has been suggested as mortality seems to increase after 30 days, the authors decided to use it nonetheless, as none of the mentioned scores are sufficiently conclusive. To justify this approach, all-hospital death was also included in the analysis. Thus, a retrospective analysis of the endocarditis registry was performed to evaluate risk factors for 30-day mortality and, in turn, explore the question of operability and the potential benefit of surgical intervention for these critically ill patients.