Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
Surg Infect (Larchmt). 2022 Feb;23(1):53-60. doi: 10.1089/sur.2021.130. Epub 2021 Oct 7.
Necrotizing soft tissue infections (NSTIs) are rapidly progressing, life-threatening diseases associated with substantial morbidity and mortality, especially in patients 65 years or older. We aimed to evaluate clinical factors associated with mortality and discharge disposition after NSTIs in elderly patients. Retrospective data were obtained from the 2007-2017 American College of Surgeons-National Surgical Quality (ACS-NSQIP) database. Patients aged 65 years or older with a post-operative diagnosis of an NSTI (defined as gas gangrene, necrotizing fasciitis, or Fournier gangrene) were included. Univariable and multivariable analyses were performed to identify independent clinical and demographic factors associated with mortality and with discharge disposition. A total of 1,460 patients were included. Median age was 71 years, 43% were females. Overall, 30-day mortality was 18.5% and 30-day morbidity was 63.6%. The most important predictors of mortality included pre-operative septic shock (odds ratio [OR], 6.36; 95% confidence interval [CI], 3.61-11.18), pre-operative dialysis dependence (OR, 2.99; 95% CI, 1.77-5.05), coagulopathy (international normalized ratio [INR], >1.5, OR, 2.25; 95% CI, 1.51-3.37), hepatobiliary disease (bilirubin >1.0 mg/dL; OR, 2.05; 95% CI, 1.38-3.04) and aged 80 years or older (OR, 3.36; 95% CI, 2.08-5.44). Patients without any of these risk factors had a mortality of 7.3%. Predictors of discharge to inpatient rehabilitation or skilled care included age 80 years or older (OR, 2.49; 95% CI, 1.44-4.30), American Society of Anesthesiologists (ASA) ≥3 (OR, 2.05; 95% CI, 1.03-4.05)] and amputation as opposed to debridement (OR, 2.53; 95% CI,1.48-4.32). We identified several pre-operative clinical factors that were associated with increased post-operative mortality and discharge to post-acute care. The next steps should focus on determining if optimization of modifiable predictors would improve mortality.
坏死性软组织感染（NSTI）是一种迅速进展、危及生命的疾病，与较高的发病率和死亡率相关，尤其是 65 岁及以上的患者。我们旨在评估与老年患者 NSTI 后死亡率和出院去向相关的临床因素。 回顾性数据来自 2007 年至 2017 年美国外科医师学会-国家手术质量（ACS-NSQIP）数据库。纳入术后诊断为 NSTI（定义为气性坏疽、坏死性筋膜炎或 Fournier 坏疽）的 65 岁及以上患者。进行单变量和多变量分析以确定与死亡率和出院去向相关的独立临床和人口统计学因素。 共纳入 1460 例患者。中位年龄为 71 岁，43%为女性。总体而言，30 天死亡率为 18.5%，30 天发病率为 63.6%。死亡率最重要的预测因素包括术前感染性休克（比值比[OR]，6.36；95%置信区间[CI]，3.61-11.18）、术前透析依赖（OR，2.99；95%CI，1.77-5.05）、凝血功能障碍（国际标准化比值[INR]，>1.5，OR，2.25；95%CI，1.51-3.37）、肝胆疾病（胆红素>1.0mg/dL；OR，2.05；95%CI，1.38-3.04）和 80 岁及以上（OR，3.36；95%CI，2.08-5.44）。没有这些危险因素的患者死亡率为 7.3%。住院康复或熟练护理出院的预测因素包括 80 岁或以上（OR，2.49；95%CI，1.44-4.30）、美国麻醉师协会（ASA）≥3（OR，2.05；95%CI，1.03-4.05）和截肢而非清创（OR，2.53；95%CI，1.48-4.32）。 我们确定了一些与术后死亡率增加和急性后护理出院相关的术前临床因素。下一步应重点确定是否优化可改变的预测因素会提高死亡率。
