Abstract
BackgroundIt is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30-days and amputation in patients with upper extremity NSTIs.MethodsA retrospective study over a 20-year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30-day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs.ResultsWithin 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64–52.31) and a base deficit of 3 meq/L or greater (OR 10.53, 95% CI 1.14–96.98). The independent risk factor for amputation was a NSTI of the non-dominant arm (OR 3.78, 95% CI 1.07–13.35). Length of hospital stay was 15 (IQR 9–21) days.ConclusionUpper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss.
Highlights
Necrotizing soft tissue infections (NSTIs) are rapidly spreading and progressive infection of the soft tissues, most often affecting the fascia and subcutaneous layers [1,2,3].The extremities have been described to be affected in 45–74% of all necrotizing soft tissue infections (NSTIs) cases, of which the lower extremity are most commonly involved [2, 4, 5]
Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions
American Society of Anesthesiologists (ASA) classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss
Summary
Necrotizing soft tissue infections (NSTIs) are rapidly spreading and progressive infection of the soft tissues, most often affecting the fascia and subcutaneous layers [1,2,3].The extremities have been described to be affected in 45–74% of all NSTI cases, of which the lower extremity are most commonly involved [2, 4, 5]. Most of the studies assessing upper extremity NSTIs are limited to small case series or big national database studies with less detail about the presentation and admission itself [6,7,8] Due to this low representation of upper extremity NSTIs in the literature, it is unknown what the exact short-term outcomes are and whether they are comparable to NSTIs affecting other anatomical regions. Knowledge of risk factors for mortality and morbidity provides insight into the prognosis and possibilities to improve outcomes of NSTIs of the upper extremity It is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Length of hospital stay was 15 (IQR 9–21) days
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