The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections
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 subject...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2019-10, Vol.45 (5), p.919-926 |
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| container_title | European journal of trauma and emergency surgery (Munich : 2007) |
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| creator | Latifi, Rifat Patel, Apar S. Samson, David J. Tilley, Elizabeth H. Gashi, Saranda Bergamaschi, Roberto El-Menyar, Ayman |
| description | 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 ( |
| doi_str_mv | 10.1007/s00068-018-0958-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2043169059</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2043169059</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-f34695d10dbf55a5866a20a11bb30513f9a6bcd0f8fda8e6f24aae34d294ad253</originalsourceid><addsrcrecordid>eNp1kU1rHSEUhiWk5Kv5Ad0EIZtupvVjdHQZQtoGAt2ka3HG4403czXRmcC9v77eTppAoQvxwHne9-h5EfpEyRdKSPe1EEKkagitRwvV7A7QCVWSN1q39PCt5vwYnZayrjCRgh2hY6Y7pZUUJ-jx_gFwTiMUnDwGm8ctLnNeQd5iGx0e0iblPuyL6MIUUqxgxGmeamcRFXiBDDjCkNMUdiGucEl-aqZQygw4RA_DH-FH9MHbscD5632Gfn27ub_-0dz9_H57fXXXDLxjU-N5K7VwlLjeC2GFktIyYinte04E5V5b2Q-OeOWdVSA9a60F3jqmW-uY4Gfo8-L7lNPzDGUym1AGGEcbIc3FMNJyKjURuqKX_6DrNOdYX7enWNsJxbtK0YWqPywlgzdPOWxs3hpKzD4JsyRhahJmn4TZVc3Fq_Pcb8C9Kf6uvgJsAUptxbrw99H_d_0N_7OWHQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2042475837</pqid></control><display><type>article</type><title>The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Latifi, Rifat ; Patel, Apar S. ; Samson, David J. ; Tilley, Elizabeth H. ; Gashi, Saranda ; Bergamaschi, Roberto ; El-Menyar, Ayman</creator><creatorcontrib>Latifi, Rifat ; Patel, Apar S. ; Samson, David J. ; Tilley, Elizabeth H. ; Gashi, Saranda ; Bergamaschi, Roberto ; El-Menyar, Ayman</creatorcontrib><description>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.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-018-0958-z</identifier><identifier>PMID: 29789865</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Alcohol abuse ; Clinical outcomes ; Comorbidity ; Critical Care Medicine ; Debridement - methods ; Diabetes ; Emergency Medicine ; Fasciitis, Necrotizing - physiopathology ; Fasciitis, Necrotizing - surgery ; Female ; Foot diseases ; Gangrene ; Humans ; Hypothyroidism ; Infections ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Original Article ; Peripheral neuropathy ; Retrospective Studies ; Soft Tissue Infections - physiopathology ; Soft Tissue Infections - surgery ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Surgical outcomes ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgical Procedures - methods</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2019-10, Vol.45 (5), p.919-926</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Journal of Trauma and Emergency Surgery is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-f34695d10dbf55a5866a20a11bb30513f9a6bcd0f8fda8e6f24aae34d294ad253</citedby><cites>FETCH-LOGICAL-c372t-f34695d10dbf55a5866a20a11bb30513f9a6bcd0f8fda8e6f24aae34d294ad253</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-018-0958-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-018-0958-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29789865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Latifi, Rifat</creatorcontrib><creatorcontrib>Patel, Apar S.</creatorcontrib><creatorcontrib>Samson, David J.</creatorcontrib><creatorcontrib>Tilley, Elizabeth H.</creatorcontrib><creatorcontrib>Gashi, Saranda</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>El-Menyar, Ayman</creatorcontrib><title>The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Alcohol abuse</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Critical Care Medicine</subject><subject>Debridement - methods</subject><subject>Diabetes</subject><subject>Emergency Medicine</subject><subject>Fasciitis, Necrotizing - physiopathology</subject><subject>Fasciitis, Necrotizing - surgery</subject><subject>Female</subject><subject>Foot diseases</subject><subject>Gangrene</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>Infections</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Peripheral neuropathy</subject><subject>Retrospective Studies</subject><subject>Soft Tissue Infections - physiopathology</subject><subject>Soft Tissue Infections - surgery</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical outcomes</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures - methods</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU1rHSEUhiWk5Kv5Ad0EIZtupvVjdHQZQtoGAt2ka3HG4403czXRmcC9v77eTppAoQvxwHne9-h5EfpEyRdKSPe1EEKkagitRwvV7A7QCVWSN1q39PCt5vwYnZayrjCRgh2hY6Y7pZUUJ-jx_gFwTiMUnDwGm8ctLnNeQd5iGx0e0iblPuyL6MIUUqxgxGmeamcRFXiBDDjCkNMUdiGucEl-aqZQygw4RA_DH-FH9MHbscD5632Gfn27ub_-0dz9_H57fXXXDLxjU-N5K7VwlLjeC2GFktIyYinte04E5V5b2Q-OeOWdVSA9a60F3jqmW-uY4Gfo8-L7lNPzDGUym1AGGEcbIc3FMNJyKjURuqKX_6DrNOdYX7enWNsJxbtK0YWqPywlgzdPOWxs3hpKzD4JsyRhahJmn4TZVc3Fq_Pcb8C9Kf6uvgJsAUptxbrw99H_d_0N_7OWHQ</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Latifi, Rifat</creator><creator>Patel, Apar S.</creator><creator>Samson, David J.</creator><creator>Tilley, Elizabeth H.</creator><creator>Gashi, Saranda</creator><creator>Bergamaschi, Roberto</creator><creator>El-Menyar, Ayman</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections</title><author>Latifi, Rifat ; Patel, Apar S. ; Samson, David J. ; Tilley, Elizabeth H. ; Gashi, Saranda ; Bergamaschi, Roberto ; El-Menyar, Ayman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-f34695d10dbf55a5866a20a11bb30513f9a6bcd0f8fda8e6f24aae34d294ad253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Alcohol abuse</topic><topic>Clinical outcomes</topic><topic>Comorbidity</topic><topic>Critical Care Medicine</topic><topic>Debridement - methods</topic><topic>Diabetes</topic><topic>Emergency Medicine</topic><topic>Fasciitis, Necrotizing - physiopathology</topic><topic>Fasciitis, Necrotizing - surgery</topic><topic>Female</topic><topic>Foot diseases</topic><topic>Gangrene</topic><topic>Humans</topic><topic>Hypothyroidism</topic><topic>Infections</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Peripheral neuropathy</topic><topic>Retrospective Studies</topic><topic>Soft Tissue Infections - physiopathology</topic><topic>Soft Tissue Infections - surgery</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical outcomes</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Latifi, Rifat</creatorcontrib><creatorcontrib>Patel, Apar S.</creatorcontrib><creatorcontrib>Samson, David J.</creatorcontrib><creatorcontrib>Tilley, Elizabeth H.</creatorcontrib><creatorcontrib>Gashi, Saranda</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>El-Menyar, Ayman</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Latifi, Rifat</au><au>Patel, Apar S.</au><au>Samson, David J.</au><au>Tilley, Elizabeth H.</au><au>Gashi, Saranda</au><au>Bergamaschi, Roberto</au><au>El-Menyar, Ayman</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>45</volume><issue>5</issue><spage>919</spage><epage>926</epage><pages>919-926</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29789865</pmid><doi>10.1007/s00068-018-0958-z</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 1863-9933 |
| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2019-10, Vol.45 (5), p.919-926 |
| issn | 1863-9933 1863-9941 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Alcohol abuse Clinical outcomes Comorbidity Critical Care Medicine Debridement - methods Diabetes Emergency Medicine Fasciitis, Necrotizing - physiopathology Fasciitis, Necrotizing - surgery Female Foot diseases Gangrene Humans Hypothyroidism Infections Intensive Male Medicine Medicine & Public Health Middle Aged Mortality Original Article Peripheral neuropathy Retrospective Studies Soft Tissue Infections - physiopathology Soft Tissue Infections - surgery Sports Medicine Surgery Surgical Orthopedics Surgical outcomes Traumatic Surgery Treatment Outcome Vascular Surgical Procedures - methods |
| title | The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections |
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