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

Journal of Clinical Medicine

Henning Ebelt¹  Michael Bauer²  Stefan Hagel²  Mathias W. Pletz²  Bettina Loeffler²  Thomas Lehmann³  Karim Ibrahim⁴  Christoph Sponholz⁵  Torsten Doenst⁶  Antonio Struve⁶  Mahmoud Diab⁶  Gloria Faerber⁶  Marcus Franz⁷  P. Christian Schulze⁷  Albrecht Guenther⁸  Rita Musleh⁸  Otto W. Witte⁸  Holger Sigusch⁹  Anika Penzel^1,10  Marcus Jahnecke^1,11  Henning Kuehn^1,12 

[1] Catholic Hospital St. Johann Nepomuk Erfurt, Clinic for Internal Medicine II, 99097 Erfurt, Germany;Center for Sepsis Care and Control (CSCC), Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Center of Clinical Studies, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Chemnitz Clinic, Internal Medicine I, 09113 Chemnitz, Germany;Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Department of Cardiothoracic Surgery, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Department of Internal Medicine I, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Department of Neurology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;Heinrich-Braun-Clinic Zwickau, Clinic for Internal Medicine I, 08060 Zwickau, Germany;Institute of Medical Microbiology, Jena University Hospital—Friedrich Schiller University of Jena, 07743 Jena, Germany;St. Georg Clinic Eisenach, Clinic for Internal Medicine I, 99817 Eisenach, Germany;Thuringia Clinics Georgius Agricola Saalfeld, Clinic for Internal Medicine III, 07318 Saalfeld, Germany;

关键词: infective endocarditis;    endocarditis team;    endocarditis network;   

DOI  :  10.3390/jcm10204734

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown