瘾癖咨询小组成立前后手术治疗的药物使用相关感染性心内膜炎患者的再住院情况:一项回顾性观察分析。

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI:10.1097/ADM.0000000000001368
Lucas X Marinacci, Audrey Li, Annie Tsay, Yoel Benarroch, Kevin P Hill, Adolf W Karchmer, Rishi K Wadhera, Katherine Kentoffio
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引用次数: 0

摘要

背景:因药物使用相关感染性心内膜炎(DUA-IE)而接受心脏手术的患者因复发性心内膜炎、药物使用障碍(SUD)和败血症而再次入院的比例很高。我们的主要目的是评估在这一人群中,接受成瘾咨询团队(ACT)的治疗是否与再入院率的降低有关:这项单中心回顾性分析利用胸外科医师协会数据库确定了2012年1月至2022年9月期间因DUA-IE接受心脏手术的患者,并比较了2017年9月实施ACT前后1、3、6和12个月再入院的累积发生率,考虑了死亡率竞争风险,并利用反治疗概率加权法调整了测量的混杂因素:58名患者(35名实施ACT前患者和23名实施ACT后患者)都很年轻(36.4 +/- 7.7岁),主要为白人(53.4%)和男性(70.7%)。ACT后组群的再入院风险在1个月(调整后风险差异[RD] -23.8% [95% CI -94.4%, -8.3%],P = 0.005)和3个月(RD -34.1% [-55.1%, -13.1%],P = 0.005)时明显降低,但在6个月或12个月时则没有降低。在一项敏感性分析中,ACT后队列在3个月时因SUD并发症再入院的风险也显著降低:ACT暴露与手术治疗的DUA-IE患者短期再入院风险降低有关,这可能是由于SUD相关并发症的减少。需要进行更多的研究来复制这些发现,并找出长期维持ACT潜在益处的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Readmissions Among Patients With Surgically Managed Drug Use Associated-Infective Endocarditis Before and After the Implementation of an Addiction Consult Team: A Retrospective, Observational Analysis.

Background: Patients who undergo cardiac surgery for drug use-associated infective endocarditis (DUA-IE) have high rates of readmissions for recurrent endocarditis, substance use disorder (SUD), and septicemia. Our primary objective was to assess whether exposure to an addiction consult team (ACT) was associated with reduced readmissions in this population.

Methods: This single-center retrospective analysis identified patients who underwent cardiac surgery for DUA-IE between 1/2012-9/2022 using the Society for Thoracic Surgeons database, and compared the cumulative incidence of readmissions at 1, 3, 6, and 12 months among those cared for before and after the implementation of an ACT in 9/2017, accounting for competing risk of mortality and adjusted for measured confounders using inverse probability of treatment weighting.

Results: The 58 patients (35 pre-ACT and 23 post-ACT) were young (36.4 +/- 7.7 years) and predominantly White (53.4%) and male (70.7%). The post-ACT cohort had a significantly lower risk of readmission at 1 month (adjusted risk difference [RD] -23.8% [95% CI -94.4%, -8.3%], P = 0.005) and 3 months (RD -34.1% [-55.1%, -13.1%], P = 0.005), but not at 6 or 12 months. In a sensitivity analysis, the post-ACT cohort also had significantly lower risk of readmissions for SUD complications at 3 months.

Discussion and conclusion: ACT exposure was associated with a lower risk of short-term readmission among patients with surgically managed DUA-IE, possibly due to a reduction in SUD-related complications. Additional studies are needed to replicate these findings and to identify ways to sustain the potential benefits of ACTs over the longer term.

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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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