Inconsistent Addiction Treatment for Patients Undergoing Cardiac Surgery for Injection Drug Use-associated Infective Endocarditis.

INTRODUCTION:Cases of surgical injection drug use-associated infective endocarditis (IDU-IE) are on the rise, amid the US opioid epidemic. We aimed to describe nature of perioperative addiction treatment for these patients. METHODS:This is a retrospective review of 56 surgical IDU-IE from 2011 to 2016 at a tertiary care center. Data collected included substances used, documented psychosocial consultations (social work or psychiatry), medications for addiction and evidence of enrollment in a drug rehabilitation program after discharge.Among patients with active drug use (ADU), we compared the 24-month survival of those who received comprehensive addiction treatment, defined as both psychosocial consultation and medications for opioid use disorder to that of those who received partial or no treatment. RESULTS:Out of 56 patients, 42 (75%, n = 56) received a psychosocial consultation, 23 (41.1%, n = 56) received medications for opioid use disorder and 15 (26.8% n = 56) attended a drug rehabilitation program.Forty-two patients had ADU. Among those, 20 (47.6%, n = 42) received comprehensive addiction treatment, while 28 (52.4%, n = 42) received partial or no treatment, and 10 (23.8%, n = 42) attended drug rehabilitation. Most patients with ADU who attended drug rehabilitation (9, 90%) had received comprehensive addiction treatment. All patients with ADU who received comprehensive addiction treatment were alive after 24-months, while 7 patients (25%, n = 28) who received partial or no treatment were not. CONCLUSION:Addiction treatment was inconsistent for surgical IDU-IE patients. Comprehensive addiction treatment predicted drug rehabilitation attendance, and was protective against 24-month mortality. Implementing protocols for comprehensive perioperative addiction treatment in IDU-IE patients is of the utmost importance.