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

• Published in: The American journal of surgery 2010-12, Vol.200 (6), p.790-797
• Main Authors: Mills, Megan K., B.S, Faraklas, Iris, R.N., C.C.R.N, Davis, Cherisse, R.N., M.S.N, Stoddard, Gregory J., M.P.H, Saffle, Jeffrey, M.D., F.A.C.S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Burns; Cardiovascular disease; Databases, Factual; Demographics; Diabetes; Diabetes mellitus; Disorders; Epidemiology; Fasciitis, Necrotizing - therapy; Female; Fournier Gangrene - therapy; Gangrene; Gas Gangrene - therapy; General aspects; Humans; Incidence; Infections; Inflammation; Inflammatory response; Laboratories; Male; Medical sciences; Middle Aged; Mortality; National Surgical Quality Improvement Program; Necrosis; Necrotizing fasciitis; Necrotizing soft-tissue infection; Outcomes; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality; Quality control; Quality improvement; Regression analysis; Risk factors; Sepsis; Septic shock; Soft Tissue Infections - mortality; Soft Tissue Infections - therapy; Substance abuse treatment; Surgeons; Surgery; Surgical outcomes; Survival Rate; Systemic inflammatory response syndrome; Treatment Outcome
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.06.008

Abstract Background 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. Methods 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. Results 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. Conclusions 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.