Assessing Second Debridement Timing and Mortality in Necrotizing Soft Tissue Infections

Area of Science:

• Surgical Infections
• Infectious Diseases
• Trauma Surgery

Background:

• Necrotizing soft tissue infections (NSTI) frequently require multiple surgical debridements.
• Current guidelines recommend second debridement within 24 hours of initial surgery, but evidence is limited.
• Delays in second debridement may be linked to increased mortality.

Purpose of the Study:

• To evaluate the impact of timing for second debridement on in-hospital mortality in NSTI patients.
• To assess adherence to the recommended 24-hour interval for second debridement.

Main Methods:

• Retrospective cohort study of 77 NSTI patients (01/01/08–09/01/21).
• Patients were grouped based on receiving second debridement <24 hours or ≥24 hours post-initial debridement.
• Primary outcome was in-hospital mortality; secondary outcomes included ICU length of stay and wound closure.

Main Results:

• The median time to second debridement was 40 hours.
• Only 15.6% of patients received second debridement within 24 hours.
• No significant difference in in-hospital mortality was observed between the <24-hour group (25.0%) and the ≥24-hour group (6.2%; P = .07).

Conclusions:

• Timing of second debridement within or after 24 hours did not impact in-hospital mortality in this cohort.
• Adherence to the 24-hour recommendation for second debridement is low.
• Further research is needed to determine optimal timing for second debridement in NSTI.