The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections

Rifat Latifi, Apar S. Patel, David J. Samson, Elizabeth H. Tilley, Saranda Gashi, Roberto Bergamaschi, Ayman El-Menyar

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Purpose: Severe necrotizing soft-tissue infections (NSTIs) require immediate early surgical treatment to avoid adverse outcomes. This study aims to determine the impact of early surgery and comorbid conditions on the outcomes of NSTIs. Methods: A retrospective cohort study was performed on all subjects presenting with NSTI at an academic medical center between 2005 and 2016. Patients were identified based on ICD codes. Those under the age of 18 or with intraoperative findings not consistent with NSTI diagnosis were excluded. Results: There were 115 patients with a confirmed diagnosis of NSTI with a mean age of 55 ± 18 years; 41% were females and 55% were diabetics. Thirty percent of patients underwent early surgery (< 6 h). There were no significant differences between groups in baseline characteristics. The late group (≥ 6 h) had prolonged hospital stay (38 vs. 23 days, p < 0.008) in comparison to the early group (< 6 h). With every 1 h delay in time to surgery, there is a 0.268 day increase in length of stay, adjusted for these other variables: alcohol abuse, number of debridements, peripheral vascular disease, previous infection and clinical necrosis. Mortality was 16.5%. Multivariable analysis revealed that alcohol abuse, peripheral vascular disease, diabetes, obesity, hypothyroidism, and presence of COPD were associated with an increase in mortality. Conclusions: Early surgical intervention in patients with severe necrotizing soft-tissue infections reduces length of hospital stay. Presence of comorbid conditions such as alcohol abuse, peripheral vascular disease, diabetes, obesity and hypothyroidism were associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)919-926
Number of pages8
JournalEuropean Journal of Trauma and Emergency Surgery
Volume45
Issue number5
DOIs
StatePublished - Oct 1 2019

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Keywords

  • Alcohol abuse
  • Hospital length of stay
  • Mortality
  • Necrotizing soft-tissue infection
  • Peripheral vascular disease
  • Renal insufficiency/failure
  • Time to surgery

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

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