title: Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience.
abstract: OBJECTIVE
  Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS.
  
  
  METHODS
  Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ(2)) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis.
  
  
  RESULTS
  In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance.
  
  
  CONCLUSIONS
  Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: George J
authors.initials: GJ
authors.lastname: Hadeed
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Judith
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Terrence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wachtel
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rhee
authors.affiliation: Clinical Medicine, Weill Cornell Medical College, Doha, Qatar and Clinical Research, Hamad General Hospital, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
keywords: Early surgery; and early surgery; necrotizing fasciitis; necrotizing soft tissue infections