title: Impact of timing of surgery on outcome of Vibrio vulnificus-related necrotizing fasciitis.
abstract: BACKGROUND
  The aim of this study was to evaluate the impact of timing of surgery on mortality risk in patients with necrotizing fasciitis (NF) caused by Vibrio vulnificus infection.
  
  
  METHODS
  Medical records of 121 patients (mean age, 65.2 ± 11.6 years) with V vulnificus-related NF who underwent surgical intervention between July 1998 and June 2011 were collected and reviewed retrospectively. These patients were divided into 3 groups according to the time between admission and surgical treatment as follows: those who received surgical treatment less than 12 hours after admission, those who received treatment 12 to 24 hours after admission, and those who received treatment more than 24 hours after admission. Cox regression analysis was performed to assess the effect of the timing of surgery after admission on mortality risk across the 3 groups by adjusting for potential confounding covariates.
  
  
  RESULTS
  During their hospitalization, 35 patients died, yielding a case-fatality rate of 29%. After adjustment for potential confounding covariates (age, sex, duration of prodrome before admission, severity of illness on admission, the presence of primary septicemia, hepatic disorders, chronic renal insufficiency, blood pressure less than 90/60 mm Hg on admission, surgical and antibiotic modalities, and intensive care needed), patients who underwent surgery less than 12 hours after admission had a significantly lower mortality risk compared with those who had surgery either 12 to 24 hours after admission (adjusted hazard ratio [HR], .064; 95% confidence interval [CI], 1.6 × 10⁻⁷ to .25; P = .037) or more than 24 hours after admission (adjusted HR, .0043; 95% CI, 2.1 × 10⁻⁵ to .0085; P = .002). There was no difference in mortality risk between patients who underwent surgery 12 to 24 hours after admission and those who had surgery more than 24 hours after admission (P = .849).
  
  
  CONCLUSIONS
  Our data provide important clinically based evidence for the beneficial effects of surgical treatment within 12 hours of admission for V vulnificus-related NF.
authors: Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
authors: Wai-Nang
authors: WN
authors: Chao
authors: Chin-Feng
authors: CF
authors: Tsai
authors: Horng-Rong
authors: HR
authors: Chang
authors: Khee-Siang
authors: KS
authors: Chan
authors: Chun-Hung
authors: CH
authors: Su
authors: Yuan-Ti
authors: YT
authors: Lee
authors: Kwo-Chang
authors: KC
authors: Ueng
authors: Chun-Chieh
authors: CC
authors: Chen
authors: Shiuan-Chih
authors: SC
authors: Chen
authors: Meng-Chih
authors: MC
authors: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014735:Vibrio Infections / Q000401:mortality* / Q000601:surgery*; D041261:Vibrio vulnificus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents