The Prevalence of Hospitalized Cases of Necrotizing Fasciitis: Anatomical Distribution, Amputations, and In-Hospital Mortality, 2019-2024.

BACKGROUND: Necrotizing fasciitis is a life-threatening soft-tissue infection that still carries an in-hospital mortality of 11-30% and an amputation rate of 7-22% despite modern treatment. Only limited population-based data have been available for Germany to date. METHODS: We carried out a retrospective, nationwide descriptive analysis of aggregated administrative routine data from the German DRG system. All hospitalizations with a main diagnosis of necrotizing fasciitis (ICD-10-GM: M72.6) from 2019 to 2024 were included. The prevalence, demographic features, and anatomical distribution of necrotizing fasciitis were studied, as well as the rate of major amputations and in-hospital mortality. RESULTS: There were 12 799 hospitalized cases of necrotizing fasciitis over the years of the study. The mean annual prevalence was 2.6 cases per 100 000 people; an upward trend was seen from 2022 onward. Men and patients over age 50 were overrepresented. The most commonly affected sites were the pelvic/femoral region and the lower leg. Major amputations, mainly of a lower limb, were performed in 6.7% to 9.3% of cases. The in-hospital mortality rate averaged 14.9% and remained high throughout the study period. In-hospital mortality largely depended on the anatomic site and was higher with more extensive disease. CONCLUSION: In Germany, necrotizing fasciitis is associated with a considerable disease burden, high mortality, and high amputation rates. Men and patients over age 50 are at higher risk of developing this disease, and its mortality is highest in patients with extensive disease or involvement of the proximal lower limb. These are the first robust population-based data on necrotizing fasciitis in Germany.