Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections.
Department of Surgery; Center for Outcomes Research and the Surgical Research Scholars Program
Adult; Fasciitis, Necrotizing; Female; Fournier Gangrene; Gas Gangrene; Health Care Costs; Hospitals, University; Humans; Hyperbaric Oxygenation; Length of Stay; Male; Middle Aged; Soft Tissue Infections; Survival Analysis; Treatment Outcome
Bacterial Infections and Mycoses | Clinical Epidemiology | Surgery | Translational Medical Research
BACKGROUND: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities.
METHODS: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n=14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression.
RESULTS: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p
CONCLUSION: At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.
DOI of Published Version
Surg Infect (Larchmt). 2014 Jun;15(3):328-35. doi: 10.1089/sur.2012.135. Epub 2014 May 1. Link to article on publisher's website
Shaw, Joshua J.; Psoinos, Charles M.; Emhoff, Timothy A.; Shah, Shimul A.; and Santry, Heena, "Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections." (2014). UMass Center for Clinical and Translational Science Supported Publications. 51.