Background Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years. Methods This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality. Results There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; P < 0.01; R-2 = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; P = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; P = 0.22; R-2 = 0.16). Conclusions Among patients operated within 24 h, very early surgery within 6-12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.
[1]Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China.
[2]Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China.
[3]Univ Hong Kong, Li Ka Shing Fac Med, Crit Care Med Unit, Pok Fu Lam, Hong Kong, Peoples R China.
[4]Queen Mary Hosp, Dept Adult Intens Care, Pok Fu Lam, Hong Kong, Peoples R China.
[5]Pamela Youde Nethersole Eastern Hosp, Dept Intens Care, Chai Wan, Hong Kong, Peoples R China.
[6]Ruttonjee & Tang Shiu Kin Hosp, Dept Med & Geriatr, Wan Chai, Hong Kong, Peoples R China.
[7]Queen Elizabeth Hosp, Dept Intens Care Unit, Yau Ma Tei, Hong Kong, Peoples R China.
[8]Tseung Kwan O Hosp, Dept Med, Tseung Kwan O, Hong Kong, Peoples R China.
[9]Kwong Wah Hosp, Dept Intens Care, Yau Ma Tei, Hong Kong, Peoples R China.
[10]United Christian Hosp, Dept Intens Care, Kwun Tong, Hong Kong, Peoples R China.
[11]Princess Margaret Hosp, Dept Intens Care, Kwai Chung, Hong Kong, Peoples R China.
[12]Yan Chai Hosp, Dept Intens Care, Tsuen Wan, Hong Kong, Peoples R China.
[13]Caritas Med Ctr, Sham Shui Po, Dept Intens Care Unit, Dept Med & Geriatr, Hong Kong, Peoples R China.
[14]North Dist Hosp, Dept Intens Care, Sheung Shui, Hong Kong, Peoples R China.
[15]Alice Ho Miu Ling Nethersole Hosp, Dept Med, Intens Care Unit, Tai Po, Hong Kong, Peoples R China.
[16]Tuen Mun Hosp, Dept Anaesthesia & Intens Care, Tuen Mun, Hong Kong, Peoples R China.
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