Necrotizing Soft Tissue Infections

A frequently overlooked source of fever - until its too late.

Necrotizing Soft Tissue Infections: Delayed Surgical Treatment Is Associated With Increased Number of Surgical Debridements and Morbidity

Kobayashi, Leslie MD; Konstantinidis, Agathoklis MD; Shackelford, Stacy MD; Chan, Linda S. PhD; Talving, Peep MD; Inaba, Kenji MD, FACS; Demetriades, Demetrios MD, PhD, FACS

Abstract

Background: Early surgical treatment is crucial in the management of necrotizing soft tissue infections (NSTI), a severe, potentially life threatening, rapidly progressive infection. The purpose of this study was to determine the influence of surgical procedure timing on the number of surgical debridements required.

Methods: A retrospective study including 47 patients with the diagnosis of NSTI admitted to a large academic hospital from December 2004 to December 2010 was conducted. Demographics, basic laboratories on admission, medical comorbidities, site of infection, and intraoperative culture results were compared between patients with early (≤12 hour) and late (>12 hour) surgical treatment. The x-y plot for the study population and linear regression analyses were used to define the time cut point. Outcomes included the total number of debridements, mortality, hospital length of stay, and complications. Adjustment for confounding factors was done with binary regression logistic model for categorical outcomes and analysis of covariants for continuous outcomes.

Results: Overall mortality was 17.0%. The average number of surgical debridements in patients with delay surgical treatment >12 hours from the time of emergency department admission was significantly higher than those who had an operation within 12 hours after admission (7.4 ± 2.5 vs. 2.3 ± 1.2; p < 0.001). Delayed surgical debridement was associated with significantly higher mortality, higher incidence of septic shock and renal failure, and more surgical debridements than patients with early surgical debridements. After adjusting for possible confounding factors, the average number of surgical debridements and the presence of septic shock and acute renal failure were still significantly higher in patients in whom surgery was delayed >12 hours.

Conclusion: In patients with NSTI, a delay of surgical treatment of >12 hours is associated with an increased number of surgical debridements and higher incidence of septic shock and acute renal failure.

Journal of Trauma-Injury Infection & Critical Care:

November 2011 - Volume 71 - Issue 5 - pp 1400-1405