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Table 2 Relation of treatment characteristics with mortality

From: Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years

Characteristic

Total, n (%)

Mortality, n (%)

Yes

No

Pa

 

192 (100)

53 (27.6)

139 (72.4)

 

Surgical treatment

 Debridements,b mean (SD)

7.5 (5.3)

5.2 (4.2)

8.3 (5.5)

 < 0.001

  ≤ 5

82 (42.7)

32 (60.4)

50 (36.0)

0.002

  > 5

110 (57.3)

21 (39.6)

89 (64.0)

 

 Time to 1st debrid. ≤ 12 hc

92 (47.9)

23 (43.4)

69 (49.6)

0.439

 Time to 1st debrid. ≤ 24 h

115 (59.9)

27 (50.9)

88 (63.3)

0.118

 VAC therapy

120 (62.5)

17 (32.1)

103 (74.1)

 < 0.001

 VAC changes, mean (SD)

5.3 (4.0)

4.9 (2.6)

5.4 (4.2)

0.855

  ≤ 5

82 (68.3)

9 (52.9)

73 (70.9)

0.141

  > 5

38 (31.7)

8 (47.1)

30 (29.1)

 

 Defect closure

135 (70.3)

13 (24.5)

122 (87.8)

 < 0.001

  Mesh graft

109 (56.8)

8 (15.1)

101 (72.7)

 < 0.001

  Flap

27 (14.1)

1 (1.9)

26 (18.7)

0.003

  Amputationd

46 (24.0)

17 (32.1)

29 (20.9)

0.104

  Secondary healing

37 (19.3)

6 (11.3)

31 (22.3)

0.085

HBOT

 No, not indicated

98 (51.1)

24 (45.3)

74 (53.2)

0.022

 Yes

83 (43.2)

22 (41.5)

61 (43.9)

 

 No, ineligiblee

11 (5.7)

7 (13.2)

4 (2.9)

 

Antibiotic therapy

 Number of AB, mean (SD)

4.6 (2.2)

4.3 (2.2)

4.8 (2.2)

0.153

  ≤ 3

67 (34.9)

24 (45.3)

43 (30.9)

0.062

  > 3

125 (65.1)

29 (54.7)

96 (69.1)

 

 AB groups, mean (SD)

3.3 (1.3)

3.3 (1.5)

3.3 (1.3)

0.885

  ≤ 3

110 (57.3)

29 (54.7)

81 (58.3)

0.656

  > 3

82 (42.7)

24 (45.3)

58 (41.7)

 

 Changes of AB, mean (SD)

2.5 (2.1)

2.0 (2.0)

2.7 (2.0)

0.007

  ≤ 2

115 (59.9)

37 (69.8)

78 (56.1)

0.083

  > 2

77 (40.1)

16 (30.2)

61 (43.9)

 

Hospital treatment

 ICU treatment

172 (89.6)

52 (98.1)

120 (86.3)

0.017

  Days in ICU, mean (SD)

13.3 (16.1)

13.4 (16.8)

13.2 (16.0)

0.815

  0 days

20 (10.4)

1 (1.9)

19 (13.7)

0.012

  1–7 days

82 (42.7)

30 (56.6)

52 (37.4)

 

  > 7 days

90 (46.9)

22 (41.5)

68 (48.9)

 

 Days in hospital, mean (SD)f

40.2 (26.3)

22.8 (25.1)

46.8 (23.7)

 < 0.001

  ≤ 40 days

109 (56.8)

40 (75.5)

69 (49.6)

0.001

  > 40 days

83 (43.2)

13 (24.5)

70 (50.4)

 

Complications

 Total

120 (63.5)

47 (92.2)

73 (52.9)

 < 0.001

 Infectionsg

95 (49.5)

25 (47.2)

70 (50.4)

0.693

 Sepsis/organ dysfunctionh

76 (39.6)

45 (84.9)

31 (22.3)

 < 0.001

 Impaired wound healing

46 (24.0)

5 (9.4)

41 (29.5)

0.004

 Prolonged delirium

30 (15.6)

4 (7.5)

26 (18.7)

0.057

 Stump complications

14 (7.3)

2 (3.8)

12 (8.6)

0.247

 Decubitus

9 (4.7)

1 (1.9)

8 (5.8)

0.257

 Thrombosis

9 (4.7)

2 (3.8)

7(5.0)

0.711

 Anus praeteri, j

29 (15.1)

5 (9.4)

24 (17.3)

0.259

 Ileusi

4 (2.1)

2 (3.8)

2 (1.4)

0.306

 Strokei

3 (1.6)

1 (1.9)

2 (1.4)

1.000

 Cardiac arresti

3 (1.6)

2 (3.8)

1 (0.7)

0.185

 Other complicationsi, k

11 (5.7)

5 (9.4)

6 (4.3)

0.180

  1. For calculation of percentages, the number of patients in each column (i.e., in the total cohort and in subgroups with and without mortality) was set to 100%
  2. AB antibiotics, debrid. Debridement, HBOT hyperbaric oxygen therapy, ICU intensive care unit, SD standard deviation, VAC vacuum-assisted closure
  3. aCharacteristics of subgroups with and without mortality were compared with Chi-squared test for categorical variables and with Mann–Whitney-U test for continuous variables. Significant differences are highlighted in bold
  4. bDebridements included both radical debridements and minor surgical debridements for wound conditioning performed in our hospital and/or in other hospitals or departments prior to admission to our center
  5. cTime to first debridement was calculated from the time of admission to our clinic until debridement
  6. dIn the subgroup with amputation, n = 2 patients (1.0%) obtained a minor amputation, n = 3 (1.6%) a transtibial amputation, n = 3 (1.6%) a knee disarticulation, n = 34 (17.7%) a transfemoral amputation, n = 5 (1.6%) a hip disarticulation and n = 8 (4.2%) an atypical amputation. 18 patients (9.4%) had a reamputation
  7. en = 11 patients were ineligible for HBOT due to factors specified in Additional file 1: Table S1
  8. fDefined as number of days from admission to our or to an external hospital until discharge from our hospital or death
  9. gInfections comprised externally acquired and nosocomial urinary tract infections (n = 63), Clostridium difficile infections (n = 28), pneumonia (n = 9), wound infections (n = 3) and catheter sepsis (n = 23)
  10. hThe category "sepsis/organ dysfunction" contained patients with sepsis and/or subsequent renal failure and/or failure of additional organs
  11. iExact Fisher-t-test
  12. jIn 29 patients (n = 14 with necrotizing fasciitis and n = 15 with Fournier’s gangrene), colostomy was performed prior to admission to our department
  13. kOther complications comprised acute coronary syndrome (n = 1), gastrointestinal bleeding (n = 3), requirement of resuscitation (n = 2), tumor progression (n = 1), hypoxic brain damage (n = 1), hematuria (n = 1), stoma complications (n = 1) and biliary stent occlusion (n = 1)
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World Journal of Emergency Surgery

ISSN: 1749-7922