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European Journal of Trauma and Emergency Surgery

Published in:

01-10-2019 | Original Article

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

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

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2019

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.

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Title: The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections
Authors: Rifat Latifi
Apar S. Patel
David J. Samson
Elizabeth H. Tilley
Saranda Gashi
Roberto Bergamaschi
Ayman El-Menyar
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-018-0958-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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