Changes in Infective Endocarditis Admissions in Pennsylvania During the Opioid Epidemic

Abstract [from journal]

Background: With the current opioid crisis in the US, infectious complications related to injection drug use are increasingly reported. Pennsylvania is at the epicenter of the opioid crisis with the third highest rate of drug overdose deaths in the US.

Methods: A retrospective cohort study was performed using the Pennsylvania Health Care Cost Containment Council database during 01/01/2013 to 03/31/2017 of all residents hospitalized for infective endocarditis (IE) in an acute care hospital. Patients were separated into those with (DU-IE) and without (non-DU-IE) substance use via diagnosis codes. The primary outcome was length of stay (LOS). Secondarily, we evaluated demographics, infection history, hospital charges, and insurance status.

Results: Of the 17,224 hospitalizations, 1,921 (11.1%) were in patients with DU-IE. Total quarterly IE admissions increased 20%, with a 6.5% increase in non-DU-IE admissions and 238% increase in DU-IE admissions. In adjusted models, DU-IE was not associated with significant changes in LOS (IRR 1.02, 95%CI 0.975-1.072, P = 0.363). DU-IE patients were predominantly insured by Medicaid (68.3% vs 13.4%, P < 0.001). The DU-IE patients had higher hospital charges ($86,622 vs $66,802, P<0.001). Patients in the DU-IE group were more likely to leave against medical advice (AMA) (15.7% vs 1.1%, P<0.001).

Conclusions: Our study demonstrates an increase in IE admissions, driven by an increase in admissions for DU-IE. The higher charges, proportion of patients on Medicaid, and rates of leaving AMA among the DU-IE group shows the downstream effects of the opioid crisis.