Necrotising fasciitis deaths in Australia: patient characteristics and potential areas for improvement in clinical management

Necrotising fasciitis continues to present a unique diagnostic challenge to clinicians across multiple specialties. A high index of suspicion for necrotising fasciitis, especially in high‐risk patients, urgent surgical review and aggressive debridement may reduce mortality. Background Necrotising fasciitis (NF) is a life‐threatening bacterial infection with high mortality. This retrospective study aimed to investigate patient characteristics and potential areas for improvement in clinical management in NF cases in Australia. Methods Retrospective analysis of surgical death data from all public and private Australian hospitals in every state and territory, excluding New South Wales, collected through the Australian and New Zealand Audit of Surgical Mortality for the 9‐year period, January 2009 to February 2018. Results A total of 290 NF cases were identified. Among these NF cases, obesity and diabetes mellitus were two of the most common comorbidities, with a prevalence of 26% and 41%, respectively. A total of 41 clinical management issues (CMIs) were identified among 36 NF cases. A larger proportion of NF cases had CMIs compared with non‐NF surgical mortality cases. Delay in diagnosis was the leading CMI (n = 28, 68.3%), followed by delay to surgery (n = 7, 17.1%). The majority of delayed diagnoses were attributed to non‐surgical clinicians in the hospital. Conclusion CMIs were identified in a larger proportion of NF cases than in other non‐NF surgical mortality cases, suggesting that there are areas for improvement in NF diagnosis and management in Australia. The leading potentially avoidable issue identified in NF deaths was delay in diagnosis. This highlights the importance of awareness among non‐surgical clinicians that NF is a surgical emergency requiring urgent debridement.