title: A 3-year experience with necrotizing fasciitis: favorable outcomes despite operative delays in a busy acute care hospital.
abstract: Necrotizing fasciitis is a rare severe soft tissue infection that has historically been associated with high mortality. We sought to evaluate our experience with necrotizing fasciitis focusing on outcomes based on timing of operative intervention. Our study hypothesis was that delays in surgical management would negatively impact outcomes. Fifty-four patients were identified for a retrospective chart review from January 2008 to January 2011. Data analysis included demographics, admission laboratory values, imaging results, examination findings, timing and nature of operations, length of stay (LOS), and outcomes. Surgical intervention in 12 hours or more was considered a delay in care. Our study cohort was high risk based on a high prevalence of intravenous drug abuse, diabetes mellitus, hypertension, and end-stage liver disease. The average time to surgical intervention was 18±25 hours and the overall mortality rate was 16 per cent. A delay to surgery did not impact mortality or the number of débridements and LOS. Mortality was high, 45 per cent, in patients requiring amputation. We observed a high-risk population managed with aggressive surgical care for necrotizing fasciitis. Our mortality was low compared with historical data and surgical delays did not impact outcomes. Those patients requiring amputation had worse outcomes.
authors.affiliation: Department of Surgery, Division of Trauma and Surgical Critical Care, Kern Medical Center, Bakersfield, California 93306-4018, USA. APakula333@aol.com
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Pakula
authors.forename: Ravi
authors.initials: R
authors.lastname: Kapadia
authors.forename: Brandon
authors.initials: B
authors.lastname: Freeman
authors.forename: Ruby A
authors.initials: RA
authors.lastname: Skinner
mesh_terms: D019115:Fasciitis, Necrotizing / Q000601:surgery*; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome