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Table 4 Treatment characteristics, complications and outcome of patients with and without hyperbaric oxygen therapy (HBOT)

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

Characteristic

HBOT

No, not indicated

Yes

No, ineligible

Pa

n (%)

n (%)

n (%)

Total (n = 192)

98 (51.0)

83 (43.2)

11 (5.7)

 

Surgical treatment

 Debridements,b mean (SD)

6.0 (4.1)

9.1 (5.8)

7.9 (7.3)

 < 0.001

 Time to 1st debrid. ≤ 12 hc

33 (33.7)

51 (61.4)

8 (72.7)

 < 0.001

 Time to 1st debrid. ≤ 24 h

45 (45.9)

62 (74.7)

8 (72.7)

 < 0.001

 VAC therapy

62 (63.3)

53 (63.9)

5 (45.5)

0.484

 VAC changes, mean (SD)

4.6 (3.0)

5.9 (4.7)

8.0 (5.5)

0.062

 Defect coverage

71 (72.4)

60 (72.3)

4 (36.4)

0.040

  Mesh graft

58 (59.2)

48 (57.8)

3 (27.3)

0.124

  Flap

12 (12.2)

14 (16.9)

1 (9.1)

0.597

  Amputation

21 (21.4)

20 (24.1)

5 (45.5)

0.209

  Secondary healing

14 (14.3)

20 (24.1)

3 (27.3)

0.196

 Antibiotic therapy

 Number of AB, mean (SD)

4.0 (1.9)

5.2 (2.2)

5.6 (2.9)

0.001

  ≤ 3

46 (46.9)

18 (21.7)

3 (27.3)

0.002

  > 3

52 (53.1)

65 (78.3)

8 (72.7)

 

 AB groups, mean (SD)

3.0 (1.3)

3.6 (1.2)

3.6 (1.6)

0.006

  ≤ 3

67 (68.4)

39 (47.0)

4 (36.4)

0.005

  > 3

31 (31.6)

44 (53.0)

7 (63.6)

 

 Changes of AB, mean (SD)

2.4 (1.9)

2.6 (2.0)

3.2 (3.3)

0.795

  ≤ 2

63 (64.3)

45 (54.2)

7 (63.6)

0.374

  > 2

35 (35.7)

38 (45.8)

4 (36.4)

 

Hospital treatment

 ICU treatment

79 (80.6)

82 (98.8)

11 (100.0)

 < 0.001

 Days in ICU, mean (SD)

8.2 (11.7)

18.2 (16.8)

21.4 (28.1)

 < 0.001

  0 days

19 (19.4)

1 (1.2)

0 (0.0)

 < 0.001

  1–7 days

52 (53.1)

24 (28.9)

6 (54.5)

 

  > 7 days

27 (27.6)

58 (69.9)

5 (45.5)

 

 Days in hospital, mean (SD)d

39.0 (25.2)

42.1 (24.7)

35.6 (44.4)

0.203

  ≤ 40 days

59 (60.2)

43 (51.8)

7 (63.6)

0.469

  > 40 days

39 (39.8)

40 (48.2)

4 (36.4)

 

 Infections

45 (45.9)

44 (53.0)

6 (54.5)

0.599

  Urinary tract infection

25 (25.5)

35 (42.2)

3 (27.3)

0.054

  C. difficile infection

17 (17.3)

10 (12.0)

1 (9.1)

0.523

  Pneumonia

3 (3.1)

4 (4.8)

2 (18.2)

0.079

  Wound infection

1 (1.0)

2 (2.4)

0 (0.0)

0.688

  Catheter sepsis

7 (7.1)

13 (15.7)

3 (27.3)

0.058

  Multiresistent pathogense

7 (100.0)

0 (0.0)

0 (0.0)

0.031

Complications

 Total (n = 120)

54 (56.8)

57 (68.7)

9 (81.8)

0.113

 Sepsis/organ dysfunctionf

32 (32.7)

35 (42.2)

9 (81.8)

0.006

 Impaired wound healing

22 (22.4)

21 (25.3)

3 (27.3)

0.873

 Prolonged delirium

10 (10.2)

20 (24.1)

0 (0.0)

0.013

 Stump complications

5 (5.1)

7 (8.4)

2 (18.2)

0.248

 Decubitus

2 (2.0)

5 (6.0)

2 (18.2)

0.042

 Thrombosis/embolism

4 (4.1)

3 (3.6)

2 (18.2)

0.092

 Anus praeter

6 (6.1)

20 (24.1)

3 (27.3)

0.002

 Ileus

3 (3.1)

1 (1.2)

0 (0.0)

0.604

 Stroke

0 (0.0)

3 (3.6)

0.(0.0)

0.135

 Cardiac arrest

3 (3.1)

0 (0.0)

0 (0.0)

0.232

 Other complicationsg

6 (6.1)

5 (6.0)

0 (0.0)

0.701

Outcome

 Survived

74 (75.5)

61 (73.5)

4 (36.4)

0.022

 No impairment

16 (21.6)

8 (13.1)

1 (25.0)

0.155

 Mild-moderate impairmenth

38 (51.4)

31 (50.8)

0 (0.0)

 

 Severe impairmenti

20 (27.0)

22 (36.1)

3 (75.0)

 

 Return to former homej

57 (58.2)

45 (54.2)

1 (9.1)

0.008

  1. For calculation of percentages, the number of patients in each column (i.e., HBOT no, not indicated, HBOT yes and HBOT no, ineligible) was set to 100%
  2. AB antibiotics, C difficile Clostridium difficile, debrid. Debridement, h hours, ICU intensive care unit, SD standard deviation, VAC vacuum-assisted closure
  3. aCharacteristics of the three subgroups were compared with Chi-squared test for categorical variables and with Kruskal-Wallis test for continuous variables. Significant differences are highlighted in bold
  4. bDebridements included both radical debridements and minor surgical debridements for wound conditioning
  5. cTime to first debridement was calculated from the time of admission to our hospital until debridement
  6. dDefined as number of days from admission to our or to an external hospital until discharge from our hospital or death
  7. eWound infection with multiresistant pathogens
  8. fThe category "sepsis/organ dysfunction" contained patients with sepsis and/or subsequent renal failure and/or failure of additional organs
  9. gOther complications affecting n = 11 patients 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)
  10. hMild-moderate impairment included, e.g., remaining wound defects at discharge from hospital and temporary impairment of mobility
  11. iSevere impairment comprised permanent loss of walking ability, permanent confinement to a wheelchair or to bed, incontinence, critical illness neuropathy, or post intensive care syndrome
  12. jReturn to the previous living environment without severe disabling impairment
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World Journal of Emergency Surgery

ISSN: 1749-7922