Incremental Predictive Value of Post-Baseline Surgery and the Impact of Temporal Coding on Mortality Associations in Infective Endocarditis: A Temporally Validated Cohort Study

Background

Risk prediction in infective endocarditis (IE) may be compromised when treatments occurring after the initial evaluation are incorporated as though they were baseline predictors. Surgical treatment is inherently time-dependent, yet subsequent surgery has been incorporated as a static predictor in contemporary prognostic models, potentially affecting both predictive performance and treatment–outcome associations. We evaluated whether adding subsequent surgery improves mortality prediction beyond information obtained during the initial index-episode evaluation and examined how temporal representation of surgery influences its association with mortality.