A 5-Year Evaluation of the Implementation of Triple Diagnostics for Early Detection of Severe Necrotizing Soft Tissue Disease: A Single-Center Cohort Study
| Autor: | Luke P. H. Leenen, Mirjam B. de Jong, R. K. J. Simmermacher, Falco Hietbrink, Marijke R. van Dijk, Geertje A M Govaert, Femke Nawijn, Ivar G. J. M. de Bruin, Karlijn P. J. van Wessem, Roderick M. Houwert |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Comorbidity Amputation Surgical Cohort Studies 03 medical and health sciences 0302 clinical medicine Journal Article medicine Humans Fasciitis Necrotizing Fasciitis Netherlands Retrospective Studies business.industry Mortality rate Retrospective cohort study Length of Stay Middle Aged Vascular surgery medicine.disease Surgery Intensive Care Units Early Diagnosis Amputation Cardiothoracic surgery 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology business Abdominal surgery Cohort study |
| Zdroj: | World Journal of Surgery, 43(8), 1898. Springer New York |
| ISSN: | 1432-2323 0364-2313 |
| Popis: | BACKGROUND: The standardized approach with triple diagnostics (surgical exploration with visual inspection, microbiological and histological examination) has been proposed as the golden standard for early diagnosis of severe necrotizing soft tissue disease (SNSTD, or necrotizing fasciitis) in ambivalent cases. This study's primary aim was to evaluate the protocolized approach after implementation for diagnosing (early) SNSTD and relate this to clinical outcome. METHODS: A cohort study analyzing a 5-year period was performed. All patients undergoing surgical exploration (with triple diagnostics) for suspected SNSTD since implementation were prospectively identified. Demographics, laboratory results and clinical outcomes were collected and analyzed. RESULT: Thirty-six patients underwent surgical exploration with eight (22%) negative explorations. The overall 30-day mortality rate was 25%, with an early, SNSTD-related mortality rate of 11% (n = 3). Of these, one patient (4%) underwent primary amputation, but died during surgery. No significant differences between baseline characteristics were found between patients diagnosed with SNSTD in early/indistinctive or late/obvious stage. Patient diagnosed at an early stage had a significantly shorter ICU stay (2 vs. 6 days, p = 0.031). Mortality did not differ between groups; patients who died were all ASA IV patients. CONCLUSION: Diagnosing SNSTD using the approach with triple diagnostics resulted in a low mortality rate and only a single amputation in a pre-terminal patient in the first 5 years after implementation. All deceased patients had multiple preexisting comorbidities consisting of severe systemic diseases, such as end-stage heart failure. Early detection proved to facilitate faster recovery with shorter ICU stay. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink