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Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study

INTRODUCTION: Necrotizing fasciitis (NF) is a rare complication in pregnant women. There have been no population-level data reported to date on its epidemiology, clinical features, resource utilization, and outcomes. METHODS: This was a retrospective, population-based cohort study, using the Texas I...

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Autores principales: Oud, Lavi, Watkins, Phillip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269630/
https://www.ncbi.nlm.nih.gov/pubmed/25069416
http://dx.doi.org/10.1007/s40121-014-0031-0
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author Oud, Lavi
Watkins, Phillip
author_facet Oud, Lavi
Watkins, Phillip
author_sort Oud, Lavi
collection PubMed
description INTRODUCTION: Necrotizing fasciitis (NF) is a rare complication in pregnant women. There have been no population-level data reported to date on its epidemiology, clinical features, resource utilization, and outcomes. METHODS: This was a retrospective, population-based cohort study, using the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001–2010. Hospitalizations with a diagnosis of NF were then identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 728.86. Denominator data for incidence estimates were derived from the Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage, and were used to estimate the annual total number of pregnancies (TEP). The incidence of pregnancy-associated NF (PANF), hospitalization type, clinical features, resource utilization and outcomes were examined. RESULTS: There were 4,060,201 pregnancy-associated hospitalizations and 148 PANF hospitalizations during study period. Postpartum hospitalizations accounted for 82.4% of all PANF events, and intensive care unit care was required in 61.5%. The key trends noted between 2001–2002 and 2009–2010 included rising incidence of PANF from 1.1 vs. 3.8 per 100,000 TEP-years (P = 0.0001), chronic comorbidities 0% vs. 31.7% (P = 0.0777), and development of organ failure in 9.1% vs. 31.7% (P = 0.0302). There was no significant change in total hospital charges or hospital length of stay. Three patients (2%) died in the hospital and 55% of survivors had routine home discharge. CONCLUSIONS: The present cohort of PANF is the largest reported to date. The incidence of PANF rose nearly 3.5-fold over the past decade, with most events developing following delivery hospitalization. Chronic illness has been increasingly present, along with rising severity of illness. The majority of patients required ICU care. Hospital mortality was lower than that reported for NF in the general population. The sources of the observed findings require further study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40121-014-0031-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-42696302014-12-19 Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study Oud, Lavi Watkins, Phillip Infect Dis Ther Original Research INTRODUCTION: Necrotizing fasciitis (NF) is a rare complication in pregnant women. There have been no population-level data reported to date on its epidemiology, clinical features, resource utilization, and outcomes. METHODS: This was a retrospective, population-based cohort study, using the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001–2010. Hospitalizations with a diagnosis of NF were then identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 728.86. Denominator data for incidence estimates were derived from the Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage, and were used to estimate the annual total number of pregnancies (TEP). The incidence of pregnancy-associated NF (PANF), hospitalization type, clinical features, resource utilization and outcomes were examined. RESULTS: There were 4,060,201 pregnancy-associated hospitalizations and 148 PANF hospitalizations during study period. Postpartum hospitalizations accounted for 82.4% of all PANF events, and intensive care unit care was required in 61.5%. The key trends noted between 2001–2002 and 2009–2010 included rising incidence of PANF from 1.1 vs. 3.8 per 100,000 TEP-years (P = 0.0001), chronic comorbidities 0% vs. 31.7% (P = 0.0777), and development of organ failure in 9.1% vs. 31.7% (P = 0.0302). There was no significant change in total hospital charges or hospital length of stay. Three patients (2%) died in the hospital and 55% of survivors had routine home discharge. CONCLUSIONS: The present cohort of PANF is the largest reported to date. The incidence of PANF rose nearly 3.5-fold over the past decade, with most events developing following delivery hospitalization. Chronic illness has been increasingly present, along with rising severity of illness. The majority of patients required ICU care. Hospital mortality was lower than that reported for NF in the general population. The sources of the observed findings require further study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40121-014-0031-0) contains supplementary material, which is available to authorized users. Springer Healthcare 2014-07-29 2014-12 /pmc/articles/PMC4269630/ /pubmed/25069416 http://dx.doi.org/10.1007/s40121-014-0031-0 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Research
Oud, Lavi
Watkins, Phillip
Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title_full Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title_fullStr Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title_full_unstemmed Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title_short Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study
title_sort necrotizing fasciitis associated with pregnancy: a population-based cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269630/
https://www.ncbi.nlm.nih.gov/pubmed/25069416
http://dx.doi.org/10.1007/s40121-014-0031-0
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