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; Torsten Doenst

doi:10.3390/jcm10204734

Journal of Clinical Medicine (Oct 2021)

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,
Torsten Doenst

Affiliations

Mahmoud Diab: Department of Cardiothoracic Surgery, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Marcus Franz: Department of Internal Medicine I, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Stefan Hagel: Center for Sepsis Care and Control (CSCC), Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Albrecht Guenther: Department of Neurology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Antonio Struve: Department of Cardiothoracic Surgery, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Rita Musleh: Department of Neurology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Anika Penzel: Institute of Medical Microbiology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Christoph Sponholz: Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Thomas Lehmann: Center of Clinical Studies, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Henning Kuehn: Thuringia Clinics Georgius Agricola Saalfeld, Clinic for Internal Medicine III, 07318 Saalfeld, Germany
Karim Ibrahim: Chemnitz Clinic, Internal Medicine I, 09113 Chemnitz, Germany
Marcus Jahnecke: St. Georg Clinic Eisenach, Clinic for Internal Medicine I, 99817 Eisenach, Germany
Holger Sigusch: Heinrich-Braun-Clinic Zwickau, Clinic for Internal Medicine I, 08060 Zwickau, Germany
Henning Ebelt: Catholic Hospital St. Johann Nepomuk Erfurt, Clinic for Internal Medicine II, 99097 Erfurt, Germany
Gloria Faerber: Department of Cardiothoracic Surgery, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Otto W. Witte: Department of Neurology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Bettina Loeffler: Center for Sepsis Care and Control (CSCC), Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Michael Bauer: Center for Sepsis Care and Control (CSCC), Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Mathias W. Pletz: Center for Sepsis Care and Control (CSCC), Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
P. Christian Schulze: Department of Internal Medicine I, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany
Torsten Doenst: Department of Cardiothoracic Surgery, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany

DOI: https://doi.org/10.3390/jcm10204734
Journal volume & issue: Vol. 10, no. 20
p. 4734

Abstract

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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 p 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.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

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