Necrotizing soft-tissue infections: differences in patients treated at burn centers and non-burn centers

Abstract

Necrotizing soft-tissue infections (NSTI) are often life-threatening illnesses that may be best treated at specialty care facilities such as burn centers. However, little is known about current treatment patterns nationwide. The purpose of this study was to describe the referral patterns for treatment of NSTI using a multistate discharge database and to investigate the differences in patients with NSTIs treated at burn centers and nonburn centers. The National Inpatient Sample is an all-payer inpatient database from 37 states containing data from 14 million hospital stays each year. We identified all patients with NSTI using International Classification of Disease version 9 codes for necrotizing fasciitis (728.86), gas gangrene (040.0), and Fournier's gangrene (608.83) for the years 2001 and 2004. Patients were dichotomized by location of definitive treatment--either burn centers or nonburn centers. Burn center status was ascertained from the current American Burn Association burn center directory. Patient characteristics, payer status, hospital course, mortality rates, and disposition were compared between patients treated at burn centers and nonburn centers. In 2001 and 2004, a total of 10,940 patients were identified as having a NSTI. The majority (87.1%) of these patients received definitive care at nonburn centers. Patients treated at burn centers were more likely to be transferred from another hospital (OR 2.0, CI 1.8-2.2) and were more likely to have Medicaid (22.6% vs 16.3%, OR 1.39) or be uninsured (18.8% vs 13.7%, OR 1.38). Patients treated at burn centers had more surgical procedures (4.6 vs 4.3, P < .01), and higher hospital charges ($101,800 vs $68,500, P < .01). Total length of stay was also longer at burn centers (22.1 vs 16.0 days, P < .01). Based on a national discharge database, the majority of patients with NSTI are treated at nonburn centers. However, patients treated at burn centers were more likely to be transferred from nonburn centers, had longer lengths of stay, and underwent more operations, all of which are likely attributable to a greater severity of infection.