The Care of Necrotizing Soft-Tissue Infections: Patterns of Definitive Intervention at a Large Referral Center

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Abstract

The objective of this study was 1) to assess the methods employed in treating necrotizing soft-tissue infections (NSTIs) by an experienced referral center; 2) to characterize the patient population who is at risk for the development of NSTI and determine predictors of mortality within this population; and 3) to compare outcomes between those who are transferred to a burn center after diagnosis and those who present directly to such a center. A retrospective chart review was performed on 81 patients during a 6-year period who were admitted to our institution with a diagnosis of NSTI. Once admitted, variables associated with surgical and medical management were collected, and patient outcomes were recorded. All variables were analyzed for their prognostic value. Multiple comorbidities were common, with obesity being the most common preexisting condition. Acute kidney injury and multiple organ failure on admission were found to be predictive for increased mortality (P < .01). Patients who presented directly to our institution were quicker to grafting (P = .04) and underwent fewer total operations (P = .05) than transferred patients. Overall mortality was 20% and was comparable across direct admits vs transfers, and over time. NSTI remains a significant source of morbidity and mortality, especially in obese patients and those with significant comorbidities. Treatment at a burn center may reduce morbidity; however, associated mortality remains constant. Similarly, while hospital course and morbidity at our institution may be improved from years past, mortality has remained consistent over time.

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