Outcomes from treatment of necrotizing soft-tissue infections: Results from the National Surgical Quality Improvement Program database

ArticleinAmerican journal of surgery 200(6):790-6; discussion 796-7 · December 2010with13 Reads
DOI: 10.1016/j.amjsurg.2010.06.008 · Source: PubMed
Abstract
Necrotizing soft-tissue infections (NSTIs) are a group of uncommon, rapidly progressive, potentially fatal disorders. The National Surgical Quality Improvement Program (NSQIP) Registry was used to determine current data on the incidence, treatment, and outcomes of NSTIs. There were 688 NSTI cases identified for years 2005 to 2008. Ten control patients for each NSTI patient were also selected. Demographic, laboratory, and outcome data were collected to compare both groups. Evidence of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock occurred in 83% of NSTI cases. Mortality was 12% for NSTI patients versus 2% for controls. Regression analysis showed that age, emergent surgery, transfer from an outside hospital, sepsis, and several comorbid diseases correlated with mortality but not sex or diabetes. Direct admission was associated with reduced mortality. NSTIs are seen regularly in academic centers, and their incidence may be increasing. Despite a high incidence of comorbid conditions and frequent presentation with sepsis, mortality is lower than previously reported, reflecting ongoing progress in the treatment of these disorders at NSQIP hospitals.
    • "J AM ACAD DERMATOL VOLUME jj, NUMBER j Hua et al 7.e2 Supplementary Table I. Mortality of necrotizing soft-tissue infection S1-S91 Authors Year n* Mortality, % Authors Year n* Mortality, % Francis et al S91 1993 25 24 Miller et al S47 2008 11 36 Brown et al S90 1994 54 35 Gunter et al S46 2008 52 10 McHenry et al S89 1995 65 29 Su et al S44 2008 209 15.8 Bosshardt et al S88 1996 45 27 Bair et al S45 2009 85 17 Hung et al S86 1996 42 23 Khanna et al S38 2009 118 15 Elliott et al S87 1996 198 25.3 Kara et al S37 2009 15 20 Kaul et al S85 1997 77 34 Anaya et al S34 2009 350 16.9 Bilton et al S83 1998 68 21 Boyer et al S43 2009 106 40.6 Hsiao et al S84 1998 34 27 Pham et al S42 2009 297 22.5 Dahm et al S81 2000 44 20 Krieg et al S41 2009 26 19.2 Wall et al S82 2000 21 29 Hong et al S36 2009 195 14.4 Singh et al S77 2002 75 27 Czymek et al S35 2009 33 18.2 Gallup et al S79 2002 23 13 Dworkin et al S40 2009 80 15 Childers et al S80 2002 163 28 Mills et al S30 2010 688 12 Cabrera et al S76 2002 15 13 Chen et al S32 2010 40 19.5 Norton et al S78 2002 33 9 Salvador et al S31 2010 67 36 Wong et al S75 2003 89 21.3 Nisbet et al S33 2011 82 30 Tillou et al S72 2004 46 17 Simsek Celik et al S29 2011 20 20 Qazi et al S73 2004 25 24 Lee et al S28 2011 46 15.2 Schnall S74 2004 99 18 Kao et al S26 2011 296 17 Hassel et al S71 2004 14 29 Huang et al S24 2011 472 12.1 Wilkinson and Doolette S70 2004 44 14 Mitchell et al S22 2011 58 29 Escobar et al S61 2005 42 12 Yeung et al S27 2011 29 28 Kao et al S62 2005 59 12 Kobayashi et al S25 2011 47 17 Cheng et al S64 2005 17 65 Bernal et al S23 2012 393 7.6 Endorf et al S66 2005 65 17 Pakula et al S9 2012 54 16 Tiu et al S67 2005 48 29 Das et al S8 2012 249 23.5 Taviloglu et al S65 2005 98 35 Suwantarat et al S15 2012 58 22 Liu et al S63 2005 87 33 Martinschek et al S12 2012 55 16.4 Bakleh et al S69 2005 81 20 Tunovic et al S21 2012 130 13.1 Anaya et al S68 2005 166 16.9 Altarac et al S19 2012 41 36.6 Ozalay et al S59 2006 22 14 Jim enez-Pacheco et al S18 2012 37 13.5 Ogilvie and Miclau S60 2006 150 9 Tsai et al S20 2012 143 15.4 Kwan et al S58 2006 36 36 Massey et al S17 2012 95 17.5 Mulla et al S57 2007 216 11.1 Sugihara et al S14 2012 379 17.1 Lee et al S49 2007 74 15 Vayvada et al S16 2013 30 20 Basoglu et al S53 2007 45 8.8 Arifi et al S13 2013 22 22.3 Yilmazlar et al S52 2007 67 49 Tsitsilonis et al S11 2013 24 20.8 Peer et al S54 2007 38 21 Bucca et al S10 2013 20 8.3 Golger et al S55 2007 99 20 Chao et al S6 2013 121 29 Tsai et al S56 2007 32 31 Swain et al S7 2013 15 20 Yaghoubian et al S51 2007 124 17 Keung et al S5 2013 201 35 Rajput et al S39 2008 30 26.6 Proud et al S2 2014 219 15.9 Frazee et al S50 2008 122 16.4 Schwartz et al S3 2013 174 10.9 Hsiao et al S48 2008 128 19 Wang and Lim S1 2014 115 20.9 Lin et al S4 2013 75 16 "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Necrotizing soft-tissue infection (NSTI) is uncommon but life-threatening. A recent meta-analysis estimated the overall mortality at 23.5%. Objective: We sought to identify risk factors associated with mortality in a cohort of patients with NSTI in a tertiary care center. Methods: We identified 512 patients with NSTI between 1996 and 2012 in the national hospital database Program for Medicalization of Information Systems and examined risk factors of mortality with NSTI by univariate and multivariate analysis. Results: We included 109 patients with a confirmed diagnosis of NSTI; 31 (28%) died at a median follow-up of 274 days (range 2-6135 days). On multivariate analysis, independent risk factors of mortality were age older than 75 years (hazard ratio [HR] 4.4, 95% confidence interval [CI] 1.8-10.3), multifocal NSTI (HR 5.9, 95% CI 1.9-18.5), severe peripheral vascular disease (HR 5.1, 95% CI 1.5-17.0), hospital-acquired infection (HR 3.9, 95% CI 1.4-10.7), severe sepsis (HR 7.4, 95% CI 1.7-33.1), and septic shock on hospital admission (HR 13.9, 95% CI 3.8-50.4). Limitations: This was a retrospective cohort, which disallows a precise record of the delay between diagnosis and surgery. Conclusion: Our findings for this robust cohort of patients with a definite diagnosis of NSTI could help clinicians stratify NSTI severity at clinical course onset.
    Full-text · Article · Sep 2015
    • "Some of the risk factors associated with NSTIs include Type 2 Diabetes Mellitus (DM2), obesity, smoking, immobility, alcohol abuse, cirrhosis of the liver, HIV, intravenous drug abuse (IVDA), and malnutrition [9,10]. Treatment typically includes early broad-spectrum intravenous (IV) antibiotics, fluid resuscitation, vasopressor support, and extensive debridement [1,[11][12][13][14][15][16][17]. Fournier's Gangrene (FG) is a subset of NSTIs. "
    Full-text · Article · Jan 2015
    • "It is likely that the rate of obesity was underreported in this cohort, as can be the case in administrative data sets [27]. The rising rate of cesarean section in the US over the past decade [28] However, when chronic comorbidities were present in patients, diabetes was the predominant one, similar to reports in the general population with NF [6, 7]. These results are in agreement with reported cases and case series of PANF, with most affected patients without chronic illness. "
    [Show abstract] [Hide abstract] ABSTRACT: Results: There were 4,060,201 pregnancy-associated hospitalizations and 148 PANF hospitalizations during study period. Postpartum hospitalizations accounted for 82.4% of all PANF events, and intensive care unit care was required in 61.5%. The key trends noted between 2001–2002 and 2009–2010 included rising incidence of PANF from 1.1 vs. 3.8 per 100,000 TEP-years (P = 0.0001), chronic comorbidities 0% vs. 31.7% (P = 0.0777), and development of organ failure in 9.1% vs. 31.7% (P = 0.0302). There was no significant change in total hospital charges or hospital length of stay. Three patients (2%) died in the hospital and 55% of survivors had routine home discharge.
    Article · Jul 2014
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