Transfer status: A risk factor for mortality in patients with necrotizing fasciitis

• Published in: Surgery Vol. 150; no. 3; pp. 363 - 370
• Main Authors: Holena, Daniel N., MD, Mills, Angela M., MD, Carr, Brendan G., MD, MS, Wirtalla, Chris, BA, Sarani, Babak, MD, Kim, Patrick K., MD, Braslow, Benjamin M., MD, Kelz, Rachel R., MD, MSCE, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2011; Elsevier
• Subjects: Adult; Age Factors; Aged; Amputation - methods; Amputation - mortality; Analysis of Variance; Biological and medical sciences; Cohort Studies; Confidence Intervals; Databases, Factual; Debridement - methods; Debridement - mortality; Emergency Service, Hospital - utilization; Emergency Treatment; Epidemiology; Fasciitis, Necrotizing - diagnosis; Fasciitis, Necrotizing - mortality; Fasciitis, Necrotizing - surgery; Female; General aspects; Hospital Mortality - trends; Humans; Length of Stay; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Patient Transfer - utilization; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Factors; Surgery; Survival Analysis; Human; Connective tissue disease; Skin disease; Mortality; Patient; Epidemiology; Infection; Medicine; Treatment; Surgery; Necrotizing fasciitis; Risk factor; Bacteriosis; Transfer factor
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.06.005

Background Necrotizing fasciitis (NF) is a rapidly progressive disease that requires urgent surgical debridement for survival. Interhospital transfer (IT) may be associated with delay to operation, which could increase mortality. We hypothesized that mortality would be higher in patients undergoing surgical debridement for necrotizing fasciitis after IT compared to Emergency Department (ED) admission. Methods We performed a retrospective cohort analysis from 2000–2006 using the Nationwide Inpatient Sample. Inclusion criteria were age >18 years, primary diagnosis of NF, and surgical therapy within 72 hours of admission. Logistic regression was used to assess the relationship between admission source, patient and hospital variables, and mortality. Results We identified 9,958 cases over the study period. Patients in the ED group were more likely to be nonwhite and of lower income when compared with patients in the IT group. Unadjusted mortality was higher in the IT group than ED group (15.5% vs 8.7%, P < .001). After adjusting for potential confounders, odds of mortality were still greater in the IT (OR 2.04, CI 95% 1.60–2.59, P < .001). Conclusion Interhospital transfer is associated with increased risk of in-hospital mortality after surgical therapy for NF, a finding which persists after controlling for patient and hospital level variables.