Effect of transfer status on outcomes for necrotizing soft tissue infections

Angela M. Ingraham, Hee Soo Jung, Amy E. Liepert, Charles Warner-Hillard, Caprice C. Greenberg, John E. Scarborough

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background Whether patients with necrotizing soft tissue infections (NSTI) who presented to under-resourced hospitals are best served by immediate debridement or expedited transfer is unknown. We examined whether interhospital transfer status impacts outcomes of patients requiring emergency debridement for NSTI. Methods and materials We conducted a retrospective review studying patients with an operative diagnosis of necrotizing fasciitis, Fournier's gangrene, or gas gangrene in the 2010-2015 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files. Multivariable regression analyses determined if transfer status independently predicted 30-d mortality, major morbidity, minor morbidity, and length of stay. Results Among 1801 patients, 1243 (69.0%) were in the non-transfer group and 558 (31.0%) were in the transfer group. The transfer group experienced higher rates of 30-d mortality (14.5% versus 13.0%) and major morbidity (64.5% versus 60.1%) than the non-transfer group, which were not significant after risk adjustment (adjusted odds ratio [95% confidence interval]: 0.87 [0.62-1.22] and 1.00 [0.79-1.27], respectively). The transferred group experienced a longer median length of postoperative hospitalization (14 d [interquartile range 8-24] versus 11 d [6-20]), which maintained statistical significance after adjustment for other factors (adjusted beta coefficient [95% confidence interval]: 1.92 [0.48-3.37]; P = 0.009). Conclusions Our results suggest that interhospital transfer status is not an independent risk factor for mortality or morbidity after surgical management of NSTI. Although expedient debridement remains a basic tenet of NSTI management, our findings provide some reassurance that transfer before initial debridement will not significantly jeopardize patient outcomes should such transfer be deemed necessary.

Original languageEnglish (US)
Pages (from-to)372-378
Number of pages7
JournalJournal of Surgical Research
Volume220
DOIs
StatePublished - Dec 2017
Externally publishedYes

Keywords

  • Emergency general surgery
  • Interhospital transfers
  • Necrotizing soft tissue infection

ASJC Scopus subject areas

  • Surgery

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