Purpose
Necrotizing soft tissue infection (NSTI) of the upper extremity is characterized by
rapid progression, local tissue necrosis, systemic toxicity, and a high mortality
rate. The negative consequences of debridement are balanced against preservation of
life and limb. The primary objective of this study was to identify predictors of mortality
in upper extremity NSTI. Secondary objectives were to identify predictors of amputation,
final defect size, length of stay, and readmission within 30 days.
Methods
An institutional registry for patients with NSTI was retrospectively queried from
a single tertiary center covering a large referral population. Data on confirmed upper
extremity NSTI were used to determine patient characteristics, infection data, and
operative factors. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and
Quick Sequential Organ Failure Assessment (qSOFA) scores were calculated from primary
data to provide a measure of clinical severity. Bivariate screening identifying possible
predictors of mortality and multivariable regression was performed to control for
confounding. Similar analyses were performed for amputation, final defect size, and
readmission within 30 days.
Results
A total of 99 patients met the study criteria. In-hospital mortality occurred in 12
patients, and amputation was performed in 7 patients. Etiology, causative organism,
and clinical severity scores were variable. Logistic regression showed mortality to
be independently predicted by vasopressor dependency outside of operative anesthesia.
The relatively low number of case events, limited sample size, and multiple comparisons
limited the evaluation of lesser predictor variables. The LRINEC score did not strongly
predict amputation or death in this series.
Conclusions
Necrotizing soft tissue infection of the upper extremity carries risk of mortality
and amputation, and effective treatment requires prompt recognition, early goal-directed
resuscitation, and early debridement. The strongest independent predictor of in-hospital
mortality was vasopressor dependence outside operative anesthesia. The LRINEC score
did not strongly predict death or amputation in upper extremity NSTI.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: May 07, 2022
Accepted:
February 9,
2022
Received:
December 29,
2020
Footnotes
No benefits in any form have been received or will be received directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
