The impact of operative time on the outcomes of necrotizing soft tissue infections: a multicenter cohort study

BMC Surgery

Paul J. van Koperen¹  Jort Keizer²  Femke Nawijn³  Falco Hietbrink³  Mark van Heijl⁴ 

[1] Department of Surgery, Meander Medical Center, Hoogland, The Netherlands;Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;Department of Surgery, Diakonessenhuis, The Netherlands;

关键词: Necrotizing soft tissue infections;    Necrotizing fasciitis;    Severe necrotizing soft tissue infection;    Mortality;    Operative time;    Damage control;   

DOI  :  10.1186/s12893-021-01456-0

来源: Springer

【 摘 要 】

BackgroundThe primary aim of this study was to identify if there is an association between the operative time of the initial debridement for necrotizing soft tissue infections (NSTIs) and the mortality corrected for disease severity.MethodsA retrospective multicenter study was conducted of all patients with NSTIs undergoing surgical debridement. The primary outcome was the 30-day mortality. The secondary outcomes were days until death, length of intensive care unit (ICU) stay, length of hospital stay, number of surgeries within first 30 days, amputations and days until definitive wound closure.ResultsA total of 160 patients underwent surgery for NSTIs and were eligible for inclusion. Twenty-two patients (14%) died within 30 days and 21 patients (13%) underwent an amputation. The median operative time of the initial debridement was 59 min (IQR 35–90). In a multivariable analyses, corrected for sepsis just prior to the initial surgery, estimated total body surface (TBSA) area affected and the American Society for Anesthesiologists (ASA) classification, a prolonged operative time (per 20 min) was associated with a prolonged ICU (β 1.43, 95% CI 0.46–2.40; p = 0.004) and hospital stay (β 3.25, 95% CI 0.23–6.27; p = 0.035), but not with 30-day mortality. Operative times were significantly prolonged in case of NSTIs of the trunk (p = 0.044), in case of greater estimated TBSA affected (p = 0.006) or if frozen sections and/or Gram stains were assessed intra-operatively (p < 0.001).ConclusionsProlonged initial surgery did not result in a higher mortality rate, possible because of a short duration of surgery in most studied patients. However, a prolonged operative time was associated with a prolonged ICU and hospital stay, regardless of the estimated TBSA affected, presence of sepsis prior to surgery and the ASA classification. As such, keeping operative times as limited as possible might be beneficial for NSTI patients.

【 授权许可】

CC BY