Interhospital Transfer Patients With Necrotizing Soft Tissue Infections: An Evaluation of the Role for Pretransport
Hans V Strobl1, Diane N Haddad1, Renee Bicaba1
1Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA.
Background:
Early debridement is the cornerstone of treatment for necrotizing soft tissue infections (NSTI), but patients are frequently transferred for management. We described practice patterns, hypothesizing that pre-transfer NSTI debridement is associated with improved outcomes.
Methods:
We analyzed data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for Massachusetts, Wisconsin, and Colorado in 2022. NSTI patients and the subset undergoing operation before transfer (PRE) were identified. The primary outcome was mortality. We performed multivariable logistic regression adjusting for demographics, weekend transfer, severe sepsis or septic shock, and Charlson comorbidity index (CCI). Secondary outcomes were length of stay (LOS) and hospital charges.
Results:
We identified 243 transferred NSTI patients. Mean age (SD) was 56.7 (14.5) years, and 74 (30.5%) were female. There were 127 referring and 52 receiving centers, with a wide range of case volume and PRE rates. Seventy-seven (31.7%) patients were PRE; there was no difference in rates of sepsis between these patients and the remainder (41.6% vs. 37.4%, p = 0.531). Mortality with and without pre-transfer operation was 7/77 (9.1%) versus 10/166 (6.0%), with aOR = 1.62 for PRE, (p = 0.38). Pre- and post-transfer median LOS were longer for PRE (4 vs. 0 days at the referring hospital, p < 0.001; 15 vs. 10 days at the receiving hospital, p = 0.01), and PRE had higher median charges before ($66,214.50 vs. $11,227.50, p < 0.001) and after transfer ($161,615 vs. $89,728, p = 0.012).
Conclusion:
Among transferred NSTI patients, mortality did not differ between PRE and the remainder of the cohort. PRE patients had longer hospital stays and higher healthcare charges, possibly due to worse physiology or more complex wounds.
