Abstract 12884: Impact of an Addiction Consult Team on the Management and Outcomes of Patients With Surgically Managed Drug Use Associated Infective Endocarditis

Background: Recurrent injection drug use is a major driver of poor long term outcomes in patients who undergo surgery for drug use associated infective endocarditis (DUA-IE). The effect of an inpatient addiction consult team (ACT) on this population is not well described.

Methods: To assess the impact of an ACT on DUA-IE patients, we performed a single center retrospective review of all adults who underwent surgery for active DUA-IE and survived to discharge (DC) between 2012-2022 at a large academic teaching institution. An ACT was established in 9/2017. We compared measures of substance use disorder (SUD) care, readmission, reinfection, and death pre- and post- ACT implementation using logistic regression models.

Results: The pre- and post-ACT groups were similar at baseline (Table 1). In a univariate analysis, post-ACT patients were more likely to receive medications for opiate use disorder (MOUD) pre-operatively, to receive MOUD at DC, and to have MOUD follow up appointments scheduled at DC. They were less likely to receive non-MOUD opiates at DC or to be readmitted at 30 or 90 days. Overall rates of SUD follow up care scheduled prior to DC were low. There were no differences in harm reduction measures, recurrent IE, or death. In a multivariate analysis, the association of the ACT with decreased 90 day readmissions remained significant (Table 2).

Conclusion: Among surgically managed DUA-IE patients, ACT implementation was associated with improved metrics of SUD care and readmissions at 90 days, but not recurrent IE or death. Future efforts should focus on strengthening harm reduction interventions and ensuring SUD follow up to sustain longitudinal engagement in care.