Hyperbaric oxygen therapy in necrotizing soft tissue infections. J Surg Res 2012 Sep;177(1):146-51
Date
04/11/2012Pubmed ID
22487383DOI
10.1016/j.jss.2012.03.016Scopus ID
2-s2.0-84865062697 (requires institutional sign-in at Scopus site) 49 CitationsAbstract
BACKGROUND: Surgical debridement and antibiotics are the mainstays of therapy for patients with necrotizing soft tissue infections (NSTIs), but hyperbaric oxygen therapy (HBO) is often used as an adjunctive measure. Despite this, the efficacy of HBO remains unclear. We hypothesized that HBO would have no effect on mortality or amputation rates.
METHODS: We performed a retrospective analysis of our institutional experience from 2005 to 2009. Inclusion criteria were age > 18 y and discharge diagnosis of NSTI. We abstracted baseline demographics, physiology, laboratory values, and operative course from the medical record. The primary endpoint was in-hospital mortality; the secondary endpoint was extremity amputation rate. We compared baseline variables using Mann-Whitney, chi-square, and Fisher's exact test, as appropriate. Significance was set at P < 0.05.
RESULTS: We identified 80 cases over the study period. The cohort was 54% male (n = 43) and 53% white (n = 43), and had a mean age of 55 ± 16 y. There were no significant differences in demographics, physiology, or comorbidities between groups. In-hospital mortality was not different between groups (16% in the HBO group versus 19% in the non-HBO group; P = 0.77). In patients with extremity NSTI, the amputation rate did not differ significantly between patients who did not receive HBO and those who did (17% versus 25%; P = 0.46).
CONCLUSIONS: Hyperbaric oxygen therapy does not appear to decrease in-hospital mortality or amputation rate after in patients with NSTI. There may be a role for HBO in treatment of NSTI; nevertheless, consideration of HBO should never delay operative therapy. Further evidence of efficacy is necessary before HBO can be considered the standard of care in NSTI.
Author List
Massey PR, Sakran JV, Mills AM, Sarani B, Aufhauser DD Jr, Sims CA, Pascual JL, Kelz RR, Holena DNAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Fasciitis, Necrotizing
Female
Humans
Hyperbaric Oxygenation
Male
Middle Aged
Pennsylvania
Retrospective Studies
