Outcomes in Necrotizing Soft Tissue Infections Are Worse in Rural vs Urban Montana: A 10-Year Single Center Retrospective Review

Abstract

Introduction: Time to definitive surgical debridement has been identified as a predictor for morbidity and mortality in necrotizing soft-tissue infections (NSTI). Rural patients are particularly at risk due to limited local resources, prolonged transport times, and access to care. The aim was to examine the outcomes of NSTI requiring surgical treatment within the context of Montana’s diverse urban-rural and racial setting. Methods: This retrospective study (2010-2020) explored electronic patient hospital records ≥18 years old with a NSTI (via ICD9/10 code) in Montana. Rural-Urban Continuum Codes (RUCC; characterizing counties by population size) were used to distinguish urban (≤3) to rural (≥4) counties, and race (American Indian/Alaskan Native (AI/AN) and White) self-described. Variables compared using 2-tailed statistical tests. Results: A total of 177 patients were identified. There was a significantly lower patient average age in AI/AN compared with White patients with no preexisting condition delineation. Diabetes was significantly higher in rural vs urban patients. NSTI infections showed a higher incidence in both rural areas and AI/AN patients. In addition, these two groups showed extended distance for treatment. White patients had a significantly different infection location than AI/AN. Further, polymicrobial species were significantly more prevalent in AI/AN patients. Morbidities (defined as amputation and/ or septic shock) were significantly increased in rural environments and AI/AN patients. There was no significant difference in all-cause mortality between groups. Conclusion: With diverse geography, excessive distances to regional trauma facilities, and distinct racial make-up, the state of Montana presents unique challenges to optimizing NSTI treatment and outcomes.