TY - JOUR
T1 - Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections
T2 - A single academic center experience
AU - Hadeed, George
AU - Smith, Judith
AU - O'Keeffe, Terrence
AU - Kulvatunyou, Narong
AU - Wynne, Julie
AU - Joseph, Bellal
AU - Friese, Randall
AU - Wachtel, Thomas
AU - Rhee, Peter
AU - El-Menyar, Ayman
AU - Latifi, Rifat
N1 - Publisher Copyright:
© 2016 Journal of Emergencies, Trauma, and Shock.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objectives: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. Materials and Methods: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ2) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. Results: In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. Conclusions: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.
AB - Objectives: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. Materials and Methods: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ2) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. Results: In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. Conclusions: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.
KW - Early surgery
KW - and early surgery
KW - necrotizing fasciitis
KW - necrotizing fasciitis
KW - necrotizing soft tissue infections
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U2 - 10.4103/0974-2700.173868
DO - 10.4103/0974-2700.173868
M3 - Article
AN - SCOPUS:84955620632
SN - 0974-2700
VL - 9
SP - 22
EP - 27
JO - Journal of Emergencies, Trauma and Shock
JF - Journal of Emergencies, Trauma and Shock
IS - 1
ER -