Impact of valvular surgery according to frailty risk in patients with infective endocarditis

Abstract

Background: Observational studies suggest that valvular surgery can reducemortality in selected patients with infective endocarditis (IE). However, thebenefit of this intervention according to frailty levels remains unclear. Our studyaims to assess the effect of valvular surgery according to frailty status in thispopulation. Methods: We performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE wereincluded. Frailty was assessed using the Hospital Frailty Risk Score. Inverseprobability of treatment weighting (IPTW) was used to balance baseline differences between groups. Results: A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% highrisk. After IPTW adjustment, in‐hospital mortality was similar both for the entire cohort between valvular and non‐valvular surgery groups (3.7% vs. 4.1%,p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) riskof frailty. However, patients at high risk of frailty had significantly lower in‐hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. Incontrast, surgery was associated with increased use of mechanical circulatorysupport and pacemaker implantation.Conclusions: Our findings suggest that there was no difference in survival betweenvalve surgery and medical management in patients at low/intermediate frailty risk,but not for high‐risk individuals.