Necrotizing Soft Tissue Infection in the Elderly: Effect of Pre-Operative Factors on Mortality and Discharge...

Area of Science:

• Medical research
• Surgical quality improvement
• Geriatric medicine

Background:

• Necrotizing soft tissue infections (NSTIs) are severe, rapidly progressing infections with high morbidity and mortality, particularly in older adults.
• Elderly patients (≥65 years) represent a vulnerable population for NSTIs, necessitating a deeper understanding of risk factors.

Purpose of the Study:

• To identify clinical factors associated with mortality in elderly patients diagnosed with NSTIs.
• To determine predictors of discharge disposition (e.g., to inpatient rehabilitation or skilled care) for elderly patients recovering from NSTIs.

Main Methods:

• Retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2017.
• Inclusion of patients aged 65 years or older with a post-operative diagnosis of NSTI (gas gangrene, necrotizing fasciitis, or Fournier gangrene).
• Univariable and multivariable analyses to identify independent predictors of mortality and discharge disposition.

Main Results:

• The study included 1,460 elderly patients; 30-day mortality was 18.5% and 30-day morbidity was 63.6%.
• Significant predictors of mortality included pre-operative septic shock, dialysis dependence, coagulopathy, hepatobiliary disease, and age 80 years or older.
• Predictors for discharge to inpatient rehabilitation or skilled care included age 80 years or older, American Society of Anesthesiologists (ASA) class ≥3, and undergoing amputation versus debridement.

Conclusions:

• Several pre-operative clinical factors significantly increase the risk of mortality and the need for post-acute care following NSTIs in elderly patients.
• Identifying and potentially optimizing modifiable risk factors could lead to improved outcomes for this patient population.