Health care costs and clinical outcomes of necrotizing soft tissue infections: an evaluation of skin-sparing surgery.

Abstract

Background: Necrotizing soft tissue infection (NSTI) is a debilitating disease process that is characterized by rapid clinical progression and extensive tissue destruction, necessitating early surgical excision. Long-term care and outcomes of the resulting complex morbid wounds remain daunting.

Objective: To review the skin-sparing surgery (SSS) approach to NSTIs and patient outcomes, including mortality rate, length of stay (LOS), and health care costs (HCC).

Methods: The electronic medical records of patients treated at an adult regional burn and wound center between 2011 and 2021 and who underwent a SSS approach to wound closure were reviewed. Patients were excluded if surgical reports did not characterize widespread fulminant tissue destruction at multiple levels and use of a SSS approach. LOS, mortality rate, readmission rates, and HCC were also evaluated.

Results: Seventy-one patients were included in the study. The mean number of SSS per patient during initial hospitalization was 3.56, and the mean number including revisions of all anatomic locations was 7.34. The initial hospital LOS averaged 23 days, and the initial encounter mortality rate was 1.4% (n = 1). The readmission rate within 30 days and within 90 days was 17% (n = 12) and 18% (n = 13), respectively. Further, 39.4% of patients were partially managed as outpatients during wound closure. The mean HCC over the treatment course, including indirect costs and direct costs, was $64 645.18 and $44 543.61, respectively.

Conclusion: The results of this study show that the SSS approach to NSTI correlates with low mortality rates, decreased LOS, and low HCC. These findings can inform future studies involving the SSS approach as well as increase awareness of this alternative technique to surgeons caring for patients with NSTI.