Abstract
Introduction: Necrotizing soft tissue infection is a potentially fatal ‘flesh-eating’ disease that requires prompt intervention to save a patient’s life. Identification of parameters that indicate worsening of the disease (predictors of mortality) is an important part in management that guides a surgeon towards rapid surgical treatment.Aims & Objectives: This retrospective study aims to identify factors that are associated with mortality in adults with NSTIs. This study also aims to propose solutions for the better management of these infection to improve surgical outcome and survival.Place and duration of study: OPD & Emergency of Surgical Unit I and II of Shaikh Zayed Hospital, Lahore over a period of 10 years between the years 2010 to 2021.Material & Methods: This is a cross-sectional epidemiological, retrospective study conducted on patients presenting in the Outpatients Department, as well as the Emergency of Surgical Unit I and II. A total of 72 patients meeting the inclusion criteria were enrolled in this study. SPSS version 23 was used for data analysis.Results: Out of 72 patients, 31.94% of patients were receiving some form of immunosuppressive treatment (n=23), out of which 7 patients lost their life (30.43%, p=0.000). There was a preexisting immunosuppressive disease in 48.61% patients (n=35), and in this subset, a total of 10 patients didn’t recover (28.57%, p=0.000). 13 out of 17 patients who died received first debridement after 12 hours from presentation (p=0.021). High mortality was seen in patients who had the presence of shock at hospital admission.Conclusion: Delay in diagnosis and surgical treatment, the presence of shock at admission accompanied by evidence of organ dysfunction, increasing comorbidity index are reasons for the higher mortality seen in these patients of NSTIs. The timing of the first surgery is of the essence thus highlighting the importance of the “Golden Hour” for the Management of NSTIs.
Highlights
Necrotizing soft tissue infection is a potentially fatal ‘flesh-eating’ disease that requires prompt intervention to save a patient’s life
Delay in diagnosis and surgical treatment, the presence of shock at admission accompanied by evidence of organ dysfunction, increasing comorbidity index are reasons for the higher mortality seen in these patients of Necrotizing soft tissue infections (NSTI)
The timing of the first surgery is of the essence highlighting the importance of the “Golden Hour” for the Management of NSTIs
Summary
Necrotizing soft tissue infection is a potentially fatal ‘flesh-eating’ disease that requires prompt intervention to save a patient’s life. ‘Necrotizing Fasciitis’, as the name suggests, involves the fascia and the term ‘Myonecrosis’ or ‘Necrotizing Myositis’ is used when the infection involves the muscles with or without skin manifestations.[4] Despite better understanding and advances in management, the fatalities from NSTIs have remained constant at around 30% for the past thirty years or more.[4,5,6] we conducted this retrospective study at our institute to identify factors that were significantly associated with mortality in adults with NSTIs. It is postulated that mortality can be predicted in patients with NSTIs due to the presence of certain indicators on hospital admission and during the course of treatment in one individual setup
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