METHODS: Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD.
RESULTS: From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality.
CONCLUSIONS: Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
方法:1994年至2022年之间,IE患者在4家德国大学医院接受了手术。进行单变量和多变量分析,以确定可能的预测因素30天/1年死亡率和复发IE和/或SD。
结果:从总IE队列(n=3991),150例患者(4.4%)合并SD。76.6%的人进行了IE的主要手术,和原发性手术的SD为23.3%。中位年龄为70.0[64.0-75.6]岁,患者多为男性(79.5%)。最常见的病原菌是肠球菌和金黄色葡萄球菌,其次是链球菌。和凝固酶阴性葡萄球菌(CoNS)。如果首先对SD进行手术,30天死亡率显着高于首次进行IE手术(25.7%vs11.4%;p=0.037),并且我们观察到1年死亡率较高的趋势。如果IE首先被治疗,我们观察到1年内复发率较高(12.2%vs0%;p=0.023).多变量分析表明,SD的初次手术是30天死亡率的独立预测因素。
结论:初次手术治疗SD是30天死亡率的独立危险因素。当IE首先接受手术治疗时,IE和/或SD的复发率较高。