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Diab, Mahmoud; Franz, Marcus; Hagel, Stefan; Guenther, Albrecht; Struve, Antonio; Musleh, Rita; Penzel, Anika; Sponholz, Christoph; Lehmann, Thomas; Kuehn, Henning; Ibrahim, Karim; Jahnecke, Marcus; Sigusch, Holger; Ebelt, Henning; Faerber, Gloria; Witte, Otto W.; Loeffler, Bettina; Bauer, Michael; Pletz, Mathias W.; Schulze, P. Christian; Doenst, Torsten

Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes

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  • Media type: E-Article
  • Title: Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
  • Contributor: Diab, Mahmoud; Franz, Marcus; Hagel, Stefan; Guenther, Albrecht; Struve, Antonio; Musleh, Rita; Penzel, Anika; Sponholz, Christoph; Lehmann, Thomas; Kuehn, Henning; Ibrahim, Karim; Jahnecke, Marcus; Sigusch, Holger; Ebelt, Henning; Faerber, Gloria; Witte, Otto W.; Loeffler, Bettina; Bauer, Michael; Pletz, Mathias W.; Schulze, P. Christian; Doenst, Torsten
  • Published: MDPI AG, 2021
  • Published in: Journal of Clinical Medicine, 10 (2021) 20, Seite 4734
  • Language: English
  • DOI: 10.3390/jcm10204734
  • ISSN: 2077-0383
  • Origination:
  • Footnote:
  • Description: <jats:p>Background: Infective endocarditis (IE) requires multidisciplinary management. We established an endocarditis team within our hospital in 2011 and a state-wide endocarditis network with referring hospitals in 2015. We aimed to investigate their impact on perioperative outcomes. Methods: We retrospectively analyzed data from patients operated on for IE in our center between 01/2007 and 03/2018. To investigate the impact of the endocarditis network on referral latency and pre-operative complications we divided patients into two eras: before (n = 409) and after (n = 221) 01/2015. To investigate the impact of the endocarditis team on post-operative outcomes we conducted multivariate binary logistic regression analyses for the whole population. Kaplan–Meier estimates of 5-year survival were reported. Results: In the second era, after establishing the endocarditis network, the median time from symptoms to referral was halved (7 days (interquartile range: 2–19) vs. 15 days (interquartile range: 6–35)), and pre-operative endocarditis-related complications were reduced, i.e., stroke (14% vs. 27%, p &lt; 0.001), heart failure (45% vs. 69%, p &lt; 0.001), cardiac abscesses (24% vs. 34%, p = 0.018), and acute requirement of hemodialysis (8% vs. 14%, p = 0.026). In both eras, a lack of recommendations from the endocarditis team was an independent predictor for in-hospital mortality (adjusted odds ratio: 2.12, 95% CI: 1.27–3.53, p = 0.004) and post-operative stroke (adjusted odds ratio: 2.23, 95% CI: 1.12–4.39, p = 0.02), and was associated with worse 5-year survival (59% vs. 40%, log-rank &lt; 0.001). Conclusion: The establishment of an endocarditis network led to the earlier referral of patients with fewer pre-operative endocarditis-related complications. Adhering to endocarditis team recommendations was an independent predictor for lower post-operative stroke and in-hospital mortality, and was associated with better 5-year survival.</jats:p>
  • Access State: Open Access