Epidemiology of lower limb necrotising fasciitis in England: A national study (2002-2022)

Necrotising fasciitis is a surgical emergency, characterised by fulminant infection of the superficial fascia, with progression to systemic toxicity, septic shock and death if not addressed urgently. The lower limb is most commonly affected. Treatment involves resuscitation, urgent surgical debridement and broad-spectrum antimicrobials. we describe the epidemiology of lower limb necrotising fasciitis in England, over a 20-year period.

This retrospective population-based cohort study analysed 2002-2022 Hospital Episode Statistics data on lower limb necrotising fasciitis in England. Patients were identified using ICD-10 and OPCS-4 codes. Demographics, comorbidities, outcomes and deprivation indices were assessed. We employed population-level analysis of admissions, complications and mortality over two decades.

Between 2002 and 2022, 2512 people were diagnosed with lower limb necrotising fasciitis. The incidence increased seven-fold, ranging from 0.1 to 0.8 per 100,000 individuals, with most cases diagnosed in patients over the age of 40 years. Over one-third of cases occurred in patients from the most socially deprived quintile. Fifty-five percent of the patients had severe comorbidities. A diagnosis of necrotising fasciitis was associated with substantial morbidity. Over 17% required limb amputation. Thirty-day mortality was 12.6% that rose to 17.4% at 90 days.

The incidence of necrotising fasciitis appears to be increasing. This may coincide with improved reporting, establishment of registry databases or an ageing population. Mortality remains high, with a 1-year mortality of 24%. Cases were more frequently observed in socially deprived groups. Public health strategies should consider socioeconomic disparities to improve access and outcomes.