Hyperbaric oxygen therapy may improve outcomes for necrotizing soft tissue infections

1. This retrospective cohort study found that the addition of hyperbaric oxygen therapy (HBOT) to surgery in patients with necrotizing soft tissue infections (NSTIs) reduced mortality, amputation and non-home discharges.

2. These effects were accompanied by longer hospital stays and higher costs.

3. In a subgroup analysis of patients with sepsis, the effects of decreased mortality, amputation, and non-home discharges persisted with no impact on length of stay and costs compared with the non-HBOT group.  

Evidence Rating Level: 2 (Good)

NSTIs are life-threatening, managed with early diagnosis, surgery, and antibiotics. The use of additional HBOT remains controversial. A previous analysis of 45,913 patients in the National Inpatient Sample (NIS) from 1988 to 2009 showed a statistically significant reduction in mortality albeit with higher hospitalization costs and longer length of stay This retrospective cohort study aimed to investigate HBOT’s ongoing role in NSTI patients and whether HBOT would still demonstrate beneficial results using data from the latest 2012-2020 update to the NIS. Among 60,481 patients admitted with a diagnosis of NSTI who underwent surgery, 600 (<1%) received HBOT. After adjusting for baseline differences between groups, HBOT was associated with reduced mortality (AOR 0.22, 95% CI 0.09–0.53, P<0.001) and amputation risk (AOR 0.73, 95% CI 0.55–0.96, P = 0.03), with longer hospital stays by 1.6 days (95%CI 0.4–2.7 days) and increased costs by $7,800 (95%CI $2,200-$13,300). HBOT was also correlated with lower odds of non-home discharge, particularly a lower risk of discharge to short-term care facilities (AOR 0.47, 95% CI 0.6–0.95, P = 0.008). In a subgroup analysis including only sepsis patients, the HBOT association with reduced mortality (AOR 0.16, 95% CI 0.06–0.46), reduced amputation risk (AOR 0.42, 95% CI 0.28–0.62), and fewer non-home discharges (AOR 0.73, 95%CI 0.56–0.95) persisted, while length of stay and cost differences between groups were not significantly different. Overall, this study found that HBOT post-surgery decreases mortality, amputation rates, and non-home discharges, with a tradeoff of increase to costs and length of stay. These findings support the use of HBOT in patients with NSTIs, particularly in those with sepsis wherein HBOT did not increase length of stay or hospital costs. 

Click to read the study in PLOSONE

Image: PD

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