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

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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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References

  1. Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignani G (1997) Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. J Urol 158:837–840

    Article  PubMed  CAS  Google Scholar 

  2. Rouse TM, Malangoni MA, Schulte WJ (1982) Necrotizing fasciitis: a preventable disaster. Surgery 92:765–770

    PubMed  CAS  Google Scholar 

  3. Escobar SJ, Slade JB Jr, Hunt TK, Cianci P (2005) Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing fasciitis reduces mortality and amputation rate. Undersea Hyperb Med 32:437–443

    PubMed  CAS  Google Scholar 

  4. Elliott DC, Kufera JA, Myers RA (1996) Necrotizing soft tissue infections: risk factors for mortality and strategies for management. Ann Surg 224:672–683

    Article  PubMed  CAS  Google Scholar 

  5. George M, Rueth N, Skarda D, Chipman J, Quickel R, Beilman G (2009) Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt) 10:21–28

    Article  Google Scholar 

  6. Jallali N, Withey S, Butler P (2005) Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg 189:462–466

    Article  PubMed  CAS  Google Scholar 

  7. Sarani B, Strong M, Pascual J, Schwab CW (2009) Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 208:279–288

    Article  PubMed  Google Scholar 

  8. Mindrup SR, Kealey GP, Fallon B (2005) Hyperbaric oxygen for the treatment of Fournier’s gangrene. J Urol 173:1975–1977

    Article  PubMed  Google Scholar 

  9. Pietrobon R, Guller U, Martins H, Menezes AP, Higgins LD, Jacobs DO (2004) A suite of web applications to streamline the interdisciplinary collaboration in secondary data analyses. BMC Med Res Methodol 4:29

    Article  PubMed  Google Scholar 

  10. Shah J, Shah A, Pietrobon R (2009) Scientific writing of novice researchers: what difficulties and encouragements do they encounter? Acad Med 84:511–516

    Article  PubMed  Google Scholar 

  11. Deyo R, Cherkin D, Ciol M (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  PubMed  CAS  Google Scholar 

  12. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55

    Article  Google Scholar 

  13. Jackson RW, Waddell JP (1973) Hyperbaric oxygen in the management of clostridial myonecrosis (gas gangrene). Clin Orthop Relat Res 96:271–276

    PubMed  Google Scholar 

  14. Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS (1990) Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 108:847–850

    PubMed  CAS  Google Scholar 

  15. Korhonen K, Kuttila K, Niinikoski J (1999) Subcutaneous tissue oxygen and carbon dioxide tensions during hyperbaric oxygenation: an experimental study in rats. Eur J Surg 165:885–890

    Article  PubMed  CAS  Google Scholar 

  16. Korhonen K (2000) Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol Suppl:7–36

  17. Brummelkamp W, Hogendyk J, Boerema I (1961) Treatment of anaerobic infections by drenching the tissue with oxygen under high atmospheric pressure. Surgery 49:299–302

    Google Scholar 

  18. Bird AD, Telfer AB (1965) Effect of hyperbaric oxygen on limb circulation. Lancet 1:355–356

    Article  PubMed  CAS  Google Scholar 

  19. Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA (1980) A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 142:915–922

    Article  PubMed  CAS  Google Scholar 

  20. Mader J, Adams K, Wallace W, Calhoun J (1990) Hyperbaric oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am 4:433–440

    PubMed  CAS  Google Scholar 

  21. Mandell GL (1974) Bactericidal activity of aerobic and anaerobic polymorphonuclear neutrophils. Infect Immun 9:337–341

    PubMed  CAS  Google Scholar 

  22. Hohn DC, MacKay RD, Halliday B, Hunt TK (1976) Effect of O2 tension on microbicidal function of leukocytes in wounds and in vitro. Surg Forum 27:18–20

    PubMed  CAS  Google Scholar 

  23. Hunt TK, Linsey M, Grislis H, Sonne M, Jawetz E (1975) The effect of differing ambient oxygen tensions on wound infection. Ann Surg 181:35–39

    Article  PubMed  CAS  Google Scholar 

  24. Knighton DR, Halliday B, Hunt TK (1984) Oxygen as an antibiotic: the effect of inspired oxygen on infection. Arch Surg 119:199–204

    Article  PubMed  CAS  Google Scholar 

  25. Kaelin CM, Im MJ, Myers RA, Manson PN, Hoopes JE (1990) The effects of hyperbaric oxygen on free flaps in rats. Arch Surg 125:607–609

    Article  PubMed  CAS  Google Scholar 

  26. Rinaldi B, Cuzzocrea S, Donniacuo M, Capuano A, Di Palma D, Imperatore F, Mazzon E, Di Paola R, Sodano L, Rossi F (2011) Hyperbaric oxygen therapy reduces the toll-like receptor signaling pathway in multiple organ failures. Intensive Care Med 37:1110–1119

    Article  PubMed  CAS  Google Scholar 

  27. Knighton DR, Halliday B, Hunt TK (1986) Oxygen as an antibiotic: a comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg 121:191–195

    Article  PubMed  CAS  Google Scholar 

  28. Unnika V (1965) Inhibition of toxin production in Clostridium perfringens in vitro by hyperbaric oxygen. Antonie Van Leeuwenhoek 31:181–186

    Article  Google Scholar 

  29. Maclennan J, Macfarlane R (1945) Toxin and antitoxin studies of gas gangrene in man. Lancet 246:301–305

    Article  Google Scholar 

  30. Marx RE, Ehler WJ, Tayapongsak P, Pierce LW (1990) Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg 160:519–524

    Article  PubMed  CAS  Google Scholar 

  31. Hunt TK, Pai MP (1972) The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 135:561–567

    PubMed  CAS  Google Scholar 

  32. Clark LA, Moon RE (1999) Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections. Respir Care Clin N Am 5:203–219

    PubMed  CAS  Google Scholar 

  33. Brown D, Davis N, Lepawsky M, Cunningham J, Kortbeek J (1994) A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 167:485–489

    Article  PubMed  CAS  Google Scholar 

  34. Majeski JA, Alexander JW (1983) Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg 145:784–787

    Article  PubMed  CAS  Google Scholar 

  35. Stamenkovic I, Lew PD (1984) Early recognition of potentially fatal necrotizing fasciitis: the use of frozen-section biopsy. N Engl J Med 310:1689–1693

    Article  PubMed  CAS  Google Scholar 

  36. Boyer A, Vargas F, Coste F, Saubusse E, Castaing Y, Gbikpi-Benissan G, Hilbert G, Gruson D (2009) Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management. Intensive Care Med 35:847–853

    Article  PubMed  Google Scholar 

  37. Freischlag JA, Ajalat G, Busuttil RW (1985) Treatment of necrotizing soft tissue infections: the need for a new approach. Am J Surg 149:751–755

    Article  PubMed  CAS  Google Scholar 

  38. Kaul R, McGeer A, Low DE, Green K, Schwartz B (1997) Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 103:18–24

    Article  PubMed  CAS  Google Scholar 

  39. Mohammedi I, Ceruse P, Duperret S, Vedrinne J, Bouletreau P (1999) Cervical necrotizing fasciitis: 10 years’ experience at a single institution. Intensive Care Med 25:829–834

    Article  PubMed  CAS  Google Scholar 

  40. Weaver LK (2011) Hyperbaric oxygen in the critically ill. Crit Care Med 39:1784–1791

    Article  PubMed  CAS  Google Scholar 

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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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Authors and Affiliations

  1. Duke-NUS Graduate Medical School, Singapore, Singapore

    Chai R. Soh, Ricardo Pietrobon, Sophia T. Chew, Dimple Rajgor, Mihir Gandhi & Jatin Shah

  2. Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Chai R. Soh & Sophia T. Chew

  3. Research on Research Group, Duke University Medical Center, Durham, NC, 27708, USA

    Ricardo Pietrobon, Dimple Rajgor, Jatin Shah & Richard E. Moon

  4. Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC, USA

    John J. Freiberger

  5. Singapore Clinical Research Institute, Singapore, Singapore

    Mihir Gandhi

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  1. Chai R. Soh
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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

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