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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