Outcome of necrotizing skin and soft tissue infections

Abstract

Background: Management of necrotizing skin and soft tissue infections (nSSTI) remains difficult, and the mortality rate has been high. We hypothesized that management of nSSTI by an emergency general surgery (EGS) service would improve outcomes.

Methods: Retrospective review of EGS patients with idiopathic nSSTI and comparison with historical controls. Demographic, co-morbidity, laboratory, and surgical data were collected. Non-parametric statistical analysis was used to evaluate differences between survivors and non-survivors. Logistic regression analysis was performed to identify risk factors for the primary outcome measure of death.

Results: Fifty-two patients met the inclusion criteria, with five deaths (9.6%). The median time to the operating room (OR) was 8.6 h. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum lactic acid concentration, and intensive care unit length of stay were significantly different for non-survivors. The APACHE II score was an independent predictor of death when controlling for age and time to OR.

Conclusions: An EGS service was associated with shorter time to OR, which may improve the outcome. Physiologic derangement, as estimated by the APACHE II score, is predictive of death from nSSTI.