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

Presented at the 62nd Annual Meeting of the Southwestern Surgical Congress, Tucson, AZ, April 21–24, 2009.
https://doi.org/10.1016/j.amjsurg.2010.06.008Get rights and content

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.

Section snippets

Basic data collection

This study was a retrospective review of the NSQIP database for the years 2005 to 2008. The Institutional Review Board of the University of Utah Health Center approved this review. As a center contributing to NSQIP, we were granted access to the database. Data queried from NSQIP is returned in a patient user file format. To maintain the highest level of data quality, only cases included in the analysis of observed to expected outcomes (observed/expected analysis) are included in the patient

Results

For the 4 years reviewed, the NSQIP database contained 635,164 cases. Of these, 688 cases were found with primary ICD-9 codes for NSTI. The NSTI cases comprised .108% of all NSQIP patients during this period. With the help of SPSS, 6,880 control cases were randomly chosen from patients in all other ICD-9 groups (CON).

Characteristics of the NSTI and control patients are provided in Table 2. In this and subsequent tables, the dataset for variables was complete (ie, a value was found in the

Comments

NSTIs remain an uncommon clinical condition. To quote a recent review, “they are frequent enough that general and specialty physicians will have to be involved with the management of at least one patient … during their practice, but are infrequent enough that familiarity with the disease will seldom be achieved.”10 Because these patients are usually critically ill and require complex surgical care, they are often referred to academic and tertiary medical centers, so it is likely that patients

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    Supported by grant number 5UL1 RR025764 from the NIH National Center for Research Resources.

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