Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes / Mahmoud Diab, Marcus Franz, Stefan Hagel, Albrecht Guenther, Antonio Struve, Rita Musleh, Anika Penzel, Christoph Sponholz, Thomas Lehmann, Henning Kuehn, Karim Ibrahim, Marcus Jahnecke, Holger Sigusch, Henning Ebelt, Gloria Faerber, Otto W. Witte, Bettina Loeffler, Michael Bauer, Mathias W. Pletz, P. Christian Schulze and Torsten Doenst

Abstract: 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 < 0.001), heart failure (45% vs. 69%, p < 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 < 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. Keywords: infective endocarditis; endocarditis team; endocarditis network

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Persons: Diab, Mahmoud [Author]; Franz, Marcus [Author]; Hagel, Stefan [Author]; Günther, Albrecht [Author]; Struve, Antonio [Author]; Musleh, Rita [Author]; Penzel, Anika [Author]; Sponholz, Christoph [Author]; Lehmann, Thomas [Author]; Kühn, Henning [Author]; Ibrahim, Karim [Author]; Jahnecke, Marcus [Author]; Sigusch, Holger [Author]; Ebelt, Henning [Author]; Färber, Gloria [Author]; Witte, Otto W. [Author]; Löffler, Bettina [Author]; Bauer, Michael [Author]; Pletz, Mathias [Author]; Schulze, Paul Christian [Author]; Doenst, Torsten [Author]
Format: eArticle
Publication:15 October 2021
Part of:Journal of Clinical Medicine 10(2021,20) Artikel-Nummer 4734, 11 Seiten