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Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample

Abstract

Purpose

Necrotising soft tissue infection (NSTI) is a deadly disease associated with a significant risk of mortality and long-term disability from limb and tissue loss. The aim of this study was to determine the effect of hyperbaric oxygen (HBO2) therapy on mortality, complication rate, discharge status/location, hospital length of stay and inflation-adjusted hospitalisation cost in patients with NSTI.

Methods

This was a retrospective study of 45,913 patients in the Nationwide Inpatient Sample (NIS) from 1988 to 2009.

Results

A total of 405 patients received HBO2 therapy. The patients with NSTI who received HBO2 therapy had a lower mortality (4.5 vs. 9.4 %, p = 0.001). After adjusting for predictors and confounders, patients who received HBO2 therapy had a statistically significantly lower risk of dying (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.29–0.83), higher hospitalisation cost (US$52,205 vs. US$45,464, p = 0.02) and longer length of stay (LOS) (14.3 days vs. 10.7 days, p < 0.001).

Conclusions

This retrospective analysis of HBO2 therapy in NSTI showed that despite the higher hospitalisation cost and longer length of stay, the statistically significant reduction in mortality supports the use of HBO2 therapy in NSTI.

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Acknowledgments

We wish to thank Dr. Tam C. Ha (Ph.D., Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore) for reading the manuscript and providing her valuable comments. Institutional (financial) support was received from Duke-NUS Graduate Medical School.

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Correspondence to Chai R. Soh.

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Soh, C.R., Pietrobon, R., Freiberger, J.J. et al. Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample. Intensive Care Med 38, 1143–1151 (2012). https://doi.org/10.1007/s00134-012-2558-4

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  • DOI: https://doi.org/10.1007/s00134-012-2558-4

Keywords

  • Hyperbaric oxygen therapy
  • Healthcare cost and utilisation project
  • National inpatient sample
  • Necrotising soft tissue infections