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

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 retrospec...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541635/
https://www.ncbi.nlm.nih.gov/pubmed/34682856
http://dx.doi.org/10.3390/jcm10204734
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author 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
author_facet 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
author_sort Diab, Mahmoud
collection PubMed
description 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.
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spelling pubmed-85416352021-10-24 Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes 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 J Clin Med Article 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. MDPI 2021-10-15 /pmc/articles/PMC8541635/ /pubmed/34682856 http://dx.doi.org/10.3390/jcm10204734 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
title Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
title_full Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
title_fullStr Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
title_full_unstemmed Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
title_short Impact of an In-Hospital Endocarditis Team and a State-Wide Endocarditis Network on Perioperative Outcomes
title_sort impact of an in-hospital endocarditis team and a state-wide endocarditis network on perioperative outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541635/
https://www.ncbi.nlm.nih.gov/pubmed/34682856
http://dx.doi.org/10.3390/jcm10204734
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