Sociodemographic Disparities in the Surgical Management and Outcomes of Necrotizing Soft Tissue Infections: A Nationwide Analysis

Abstract

INTRODUCTION: Necrotizing soft tissue infections (NSTIs) are surgical emergencies that require an early diagnosis and aggressive surgical debridement. It has been established that disparities can influence surgical care. Our aim was to assess the association of sociodemographic variables in the surgical management and outcomes of NSTIs. METHODS: Using the Nationwide Inpatient Sample (2015 to 2018), we included patients with a primary diagnosis of NSTIs. We collected demographics and clinical characteristics. Outcomes were in-hospital mortality and number of debridements. Multivariable regression models were used to identify sociodemographic factors associated with the outcomes. RESULTS: A weighted total of 119,764 NSTI admissions were identified. The mean age was 55.4 years (SD 14.88), 65% were male, and 60% were white. Overall mortality was 6.8%, and the mean number of debridements per patient was 1.84 (SD 2.32). After adjusted analysis, female sex (odds ratio 1.21, 95% CI 1.09 to 1.35) and Hispanic ethnicity (odds ratio 1.20, 95% CI 1.02 to 1.42) were associated with increased mortality. Black (incidence rate ratio 0.90, 95% CI 0.86 to 0.94) and Hispanic patients (incidence rate ratio 0.91, 95% CI 0.86 to 0.96) along with those with public insurance (incidence rate ratio 0.93, 95% CI 0.89 to 0.96) were associated with a decreased number of debridements. CONCLUSION: This study shows that there are sociodemographic disparities in the care of NSTI patients based on sex, race/ethnicity, and insurance status. Mortality was higher among minority patients, and they underwent a lower number of surgical debridements. Further work is needed to understand the root cause of this problem and to develop appropriate interventions to ensure everyone receives the highest quality of care.