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Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

OBJECTIVES: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS...

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Autores principales: Hadeed, George J., Smith, Judith, O’Keeffe, Terrence, Kulvatunyou, Narong, Wynne, Julie L., Joseph, Bellal, Friese, Randall S., Wachtel, Thomas L., Rhee, Peter M., El-Menyar, Ayman, Latifi, Rifat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766759/
https://www.ncbi.nlm.nih.gov/pubmed/26957822
http://dx.doi.org/10.4103/0974-2700.173868
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author Hadeed, George J.
Smith, Judith
O’Keeffe, Terrence
Kulvatunyou, Narong
Wynne, Julie L.
Joseph, Bellal
Friese, Randall S.
Wachtel, Thomas L.
Rhee, Peter M.
El-Menyar, Ayman
Latifi, Rifat
author_facet Hadeed, George J.
Smith, Judith
O’Keeffe, Terrence
Kulvatunyou, Narong
Wynne, Julie L.
Joseph, Bellal
Friese, Randall S.
Wachtel, Thomas L.
Rhee, Peter M.
El-Menyar, Ayman
Latifi, Rifat
author_sort Hadeed, George J.
collection PubMed
description OBJECTIVES: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. MATERIALS AND METHODS: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ(2)) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. RESULTS: In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. CONCLUSIONS: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.
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spelling pubmed-47667592016-03-08 Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience Hadeed, George J. Smith, Judith O’Keeffe, Terrence Kulvatunyou, Narong Wynne, Julie L. Joseph, Bellal Friese, Randall S. Wachtel, Thomas L. Rhee, Peter M. El-Menyar, Ayman Latifi, Rifat J Emerg Trauma Shock Original Article OBJECTIVES: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. MATERIALS AND METHODS: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ(2)) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. RESULTS: In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. CONCLUSIONS: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4766759/ /pubmed/26957822 http://dx.doi.org/10.4103/0974-2700.173868 Text en Copyright: © Journal of Emergencies, Trauma, and Shock http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Hadeed, George J.
Smith, Judith
O’Keeffe, Terrence
Kulvatunyou, Narong
Wynne, Julie L.
Joseph, Bellal
Friese, Randall S.
Wachtel, Thomas L.
Rhee, Peter M.
El-Menyar, Ayman
Latifi, Rifat
Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title_full Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title_fullStr Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title_full_unstemmed Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title_short Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience
title_sort early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: a single academic center experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766759/
https://www.ncbi.nlm.nih.gov/pubmed/26957822
http://dx.doi.org/10.4103/0974-2700.173868
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