Thirty-Day Mortality and Morbidity Outcomes in Abdominal Wall Necrotizing Soft Tissue Infections: The STANMORE Study

Necrotizing soft tissue infection is a rapidly progressive soft tissue infection with a high mortality rate. Limited contemporary data exist on abdominal wall necrotizing soft tissue infections. This study aimed to assess 30-day mortality and morbidity and identify associated clinical factors.

This was a prospective, multinational, multicenter audit of adult patients (≥ 18 years) with abdominal wall necrotizing soft tissue infection presenting between January 1 and June 30, 2022. Data on demographics, comorbidities, clinical features, treatment, and outcomes were collected. Univariate and multivariate regression analysis were performed to identify independent risk factors for morbidity and mortality.

A total of 331 patients were included from 63 centers in 27 countries. Thirty-day morbidity and mortality occurred in 200 patients (60.4%), with 47 deaths (14.2%). A LRINEC score ≥ 6 was observed in 134 out of 263 (51.0%) of cases. Common presenting signs were skin changes in 287 out of 327 cases (87.8%), pain out of proportion to clinical findings in 236 out of 311 cases (75.9%), and gas in soft tissue on imaging 210 out of 329 cases (63.8%). The median time to first antibiotics was 2 hours (Range 0-240 hours). The median time to surgery was 6 hours (Range 1-384 hours). In the mortality group, 29 out of 47 (61.7%) had diabetes, 33 out of 47 (70.2%) had hypertension, and 25 out of 47 (53.2%) had obesity. Bowel resection (38.3%, 18 out of 47), stoma formation (44.7%, 21 out of 47) and ICU admission (89.4%, 42 out of 47) were more common in the mortality group (p < 0.05, OR 7.47). On multivariable analysis, polymicrobial infection (OR 1.73 CI 1.01-2.95) and bowel resection (OR 3.10 CI 1.22-7.88) were independently associated with morbidity, while increasing age (OR 1.04 CI 1.01-1.07), elevated creatinine (OR1 CI 1.00-1.01), bowel resection (OR 7.47 CI 2.99-18.62), and longer time to antibiotics (OR 1.02, CI 1.00-1.04) were independently associated with mortality (p < 0.05).

Abdominal wall necrotizing soft tissue infection is associated with high early morbidity and mortality. Delays in recognition and treatment remain critical contributors. Risk stratification may assist early identification and management.