Outcomes from treatment of necrotizing soft-tissue infections: results from the National Surgical Quality Improvement Program database Megan K. Mills, B.S. a , Iris Faraklas, R.N., C.C.R.N. a , Cherisse Davis, R.N., M.S.N. a , Gregory J. Stoddard, M.P.H. b , Jeffrey Saffle, M.D., F.A.C.S. a, * a Department of Surgery, 3B-306, University of Utah, Health Center, 50 N. Medical Dr, Salt Lake City, UT 84132, USA; b Department of Internal Medicine, University of Utah Health Center, Salt Lake City, UT Abstract BACKGROUND: Necrotizing soft-tissue infections (NSTIs) are a group of uncommon, rapidly progressive, potentially fatal disorders. The National Surgical Quality Improvement Program (NSQIP) Registry was used to determine current data on the incidence, treatment, and outcomes of NSTIs. METHODS: There were 688 NSTI cases identified for years 2005 to 2008. Ten control patients for each NSTI patient were also selected. Demographic, laboratory, and outcome data were collected to compare both groups. RESULTS: Evidence of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock occurred in 83% of NSTI cases. Mortality was 12% for NSTI patients versus 2% for controls. Regression analysis showed that age, emergent surgery, transfer from an outside hospital, sepsis, and several comorbid diseases correlated with mortality but not sex or diabetes. Direct admission was associated with reduced mortality. CONCLUSIONS: NSTIs are seen regularly in academic centers, and their incidence may be increas- ing. Despite a high incidence of comorbid conditions and frequent presentation with sepsis, mortality is lower than previously reported, reflecting ongoing progress in the treatment of these disorders at NSQIP hospitals. © 2010 Elsevier Inc. All rights reserved. KEYWORDS: Necrotizing soft-tissue infection; Necrotizing fasciitis; National Surgical Quality Improvement Program; Outcomes; Mortality The term “necrotizing soft-tissue infection” (necrotizing soft-tissue infection [NSTI]) encompasses a heterogenous group of severe, rapidly progressive infections traditionally described with a confusing variety of terms, including “ne- crotizing fasciitis,” “Fournier’s gangrene”, “synergistic gan- grene,” and others. 1–3 Approximately 1,000 cases of NSTI are estimated to occur each year in the United States, but this number appears to have risen over the past decade. 3 These infections are often initiated by external trauma, in- cluding surgery, but they can also arise de novo, particularly in patients with predisposing factors, most frequently dia- betes. The majority of infections are polymicrobial but can also be caused by individual organisms, including Clostrid- ium, Staphylococcus, and Streptococcus sp. 4,5 These infec- Supported by grant number 5UL1 RR025764 from the NIH National Center for Research Resources. Presented at the 62nd Annual Meeting of the Southwestern Surgical Congress, Tucson, AZ, April 21–24, 2009. * Corresponding author. Tel.: 1-801-581-3595; fax: 1-801-585- 2435. E-mail address: Jeffrey.saffle@hsc.utah.edu Manuscript received March 10, 2010; revised manuscript June 15, 2010 0002-9610/$ - see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2010.06.008 The American Journal of Surgery (2010) 200, 790 –797