Necrotizing Soft-Tissue Infection: Calculating Mortality Risk

Cheryl Lynn Horton, MD

Mortality rates were higher for older and sicker patients and those requiring emergency surgery.

Researchers defined risk factors for mortality from necrotizing soft-tissue infections (NSTIs) and developed a 30-day postoperative mortality risk calculator. Using a prospectively collected dataset of all patients undergoing surgical procedures at more than 500 academic and community hospitals from 2005 to 2010, researchers identified 1392 patients with ICD-9 codes for Fournier's gangrene, necrotizing fasciitis, and gas gangrene.

Median age was 55 years, 42% of patients were female, and median body mass index was 32 kg/m2. The most common procedures performed were debridement of NSTIs to the perineum, external genitalia, and abdominal wall. Multivariate logistic regression analysis identified 7 variables that predicted mortality: age >60 years, functional dependence, American Society of Anesthesiologists class ≥4, platelet count <150,000/mm3, septic shock, emergent surgery, and dialysis dependence before surgery. The area under the receiver operating characteristic curve was 0.83.

Citation(s):

Faraklas I et al. Development and validation of a necrotizing soft-tissue infection mortality risk calculator using NSQIP. J Am Coll Surg 2013 Jul; 217:153.