INCIDENCE AND MORTALITY OF NECROTIZING FASCIITIS: A 15-YEAR RETROSPECTIVE CHART REVIEW

Necrotizing fasciitis (NF) is a severe soft-tissue infection resulting in muscle fascia and subcutaneous tissue necrosis. Treatment is emergent radical debridement of all devitalized tissues combined with broad-spectrum IV antibiotics; however, NF can still often end with a deadly result. The primary objectives were to ascertain the incidence and mortality rate of NF. The secondary objective was to determine associations with NF mortality. This was a retrospective chart review of NF cases over the course of fifteen years in six counties in Ontario, Canada (Kingston, Hastings, Lanark, Lennox and Addington, Northumberland and PEC, Leeds Grenville). The study included 197 NF cases from August 2005 to November 2020, treated by different surgical disciplines at our institution (Orthopedics, General Surgery, Plastics, Cardiac Surgery, Urology, and Gynecology). The measures for our outcomes were 30-day mortality rate and incidence per 100,000 NF. Associations between demographics, patient characteristics, LRINEC (≥6=positive) scores and 30-day mortality were also analyzed. The study included 197 patients. There were 91 (46.2%) female and 106 (53.8%) male patients, and the average age was 55 years (range 9–95). Kingston had the highest incidence at 65 cases per 100,000, with the average incidence being 32 cases per 100,000. Regarding the 30-day mortality, 37 (18.8%) patients had a fatal outcome. Sex was not statistically significant (p = 0.28); however, the age difference between those who died and those who did not was found to be significant (55.7 vs. 64.3, p = 0.001). There was also a significant association between 30-day mortality and corticosteroid use (p = 0.05). There were 22 (11.2%) patients who had amputations. The regression analysis showed amputations (OR=9.9, 95% CI 1.21–80.73, p = 0.032) and older age as significant predictors of 30-day mortality (β = 0.8 per year, 95% CI 1.02–1.14, p = 0.008). The LRINEC score was not significant (p = 0.488). The mortality rate of NF remains high, as one in five patients with NF had a fatal outcome. Older age and amputations were significantly associated with 30-day mortality. For every year the risk of dying within 30 days increased by 8%, and it was a staggering nine times higher if they had an amputation. This study offers valuable information regarding the incidence, mortality, and factors associated with NF.