Lower Extremity Necrotizing Fasciitis in Diabetic and Nondiabetic Patients: Mortality and Amputation

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Abstract

Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality (P =.004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95% CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95% CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95% CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.

Original languageEnglish (US)
JournalInternational Journal of Lower Extremity Wounds
DOIs
StatePublished - Jan 1 2019

Fingerprint

Necrotizing Fasciitis
Amputation
Lower Extremity
Odds Ratio
Confidence Intervals
Diabetes Mellitus
Mortality
Partial Thromboplastin Time
Adult Respiratory Distress Syndrome
Septic Shock
Quality Improvement
Chronic Obstructive Pulmonary Disease
Albumins
Anesthesia
Databases

Keywords

  • amputation
  • diabetes
  • mortality
  • necrotizing fasciitis

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Lower Extremity Necrotizing Fasciitis in Diabetic and Nondiabetic Patients: Mortality and Amputation",
abstract = "Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4{\%}). Patients with DM had lower mortality (P =.004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95{\%} confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95{\%} CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95{\%} CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95{\%} CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95{\%} CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95{\%} CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95{\%} CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95{\%} CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95{\%} CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.",
keywords = "amputation, diabetes, mortality, necrotizing fasciitis",
author = "Junho Ahn and Raspovic, {Katherine Marie} and Liu, {George T} and Lavery, {Lawrence A} and {La Fontaine}, Javier and Nakonezny, {Paul A} and Wukich, {Dane K}",
year = "2019",
month = "1",
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doi = "10.1177/1534734619836464",
language = "English (US)",
journal = "International Journal of Lower Extremity Wounds",
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T2 - Mortality and Amputation

AU - Ahn, Junho

AU - Raspovic, Katherine Marie

AU - Liu, George T

AU - Lavery, Lawrence A

AU - La Fontaine, Javier

AU - Nakonezny, Paul A

AU - Wukich, Dane K

PY - 2019/1/1

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N2 - Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality (P =.004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95% CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95% CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95% CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.

AB - Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality (P =.004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95% CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95% CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95% CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.

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