File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Association between time to surgery and hospital mortality in patients with community-acquired limb necrotizing fasciitis: an 11-year multicenter retrospective cohort analysis

TitleAssociation between time to surgery and hospital mortality in patients with community-acquired limb necrotizing fasciitis: an 11-year multicenter retrospective cohort analysis
Authors
Issue Date23-Jun-2024
PublisherBioMed Central
Citation
BMC Infectious Diseases, 2024, v. 24 How to Cite?
Abstract

Background

Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years.

Methods

This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality.

Results

There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; P < 0.01; R2 = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; P = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; P = 0.22; R2 = 0.16).

Conclusions

Among patients operated within 24 h, very early surgery within 6–12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.


Persistent Identifierhttp://hdl.handle.net/10722/347581
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.031

 

DC FieldValueLanguage
dc.contributor.authorLau, Chi Ho-
dc.contributor.authorLing, Lowell-
dc.contributor.authorZhang, Jack Zhenhe-
dc.contributor.authorYeung, Pui Ning Pauline-
dc.contributor.authorChan, Cheuk Yan-
dc.contributor.authorYeung, Alwin Wai Tak-
dc.contributor.authorFong, Ka Man-
dc.contributor.authorChan, Jacky Ka Hing-
dc.contributor.authorAu, Gary Ka Fai-
dc.contributor.authorLiong, Ting-
dc.contributor.authorDharmangadan, Manimala-
dc.contributor.authorChow, Fu Loi-
dc.contributor.authorLam, Koon Ngai-
dc.contributor.authorChan, Kai Man-
dc.contributor.authorLing, Steven-
dc.contributor.authorLee, Anna-
dc.date.accessioned2024-09-25T00:30:52Z-
dc.date.available2024-09-25T00:30:52Z-
dc.date.issued2024-06-23-
dc.identifier.citationBMC Infectious Diseases, 2024, v. 24-
dc.identifier.issn1471-2334-
dc.identifier.urihttp://hdl.handle.net/10722/347581-
dc.description.abstract<h3>Background</h3><p>Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years.</p><h3>Methods</h3><p>This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality.</p><h3>Results</h3><p>There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; <em>P</em> < 0.01; R<sup>2</sup> = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; <em>P</em> = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; <em>P</em> = 0.22; R<sup>2</sup> = 0.16).</p><h3>Conclusions</h3><p>Among patients operated within 24 h, very early surgery within 6–12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.</p>-
dc.languageeng-
dc.publisherBioMed Central-
dc.relation.ispartofBMC Infectious Diseases-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleAssociation between time to surgery and hospital mortality in patients with community-acquired limb necrotizing fasciitis: an 11-year multicenter retrospective cohort analysis-
dc.typeArticle-
dc.identifier.doi10.1186/s12879-024-09501-y-
dc.identifier.volume24-
dc.identifier.eissn1471-2334-
dc.identifier.issnl1471-2334-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats