Table 2.
Relation of treatment characteristics with mortality
| Characteristic | Total, n (%) | Mortality, n (%) | ||
|---|---|---|---|---|
| Yes | No | Pa | ||
| 192 (100) | 53 (27.6) | 139 (72.4) | ||
| Surgical treatment | ||||
| Debridements,b mean (SD) | 7.5 (5.3) | 5.2 (4.2) | 8.3 (5.5) | < 0.001 |
| ≤ 5 | 82 (42.7) | 32 (60.4) | 50 (36.0) | 0.002 |
| > 5 | 110 (57.3) | 21 (39.6) | 89 (64.0) | |
| Time to 1st debrid. ≤ 12 hc | 92 (47.9) | 23 (43.4) | 69 (49.6) | 0.439 |
| Time to 1st debrid. ≤ 24 h | 115 (59.9) | 27 (50.9) | 88 (63.3) | 0.118 |
| VAC therapy | 120 (62.5) | 17 (32.1) | 103 (74.1) | < 0.001 |
| VAC changes, mean (SD) | 5.3 (4.0) | 4.9 (2.6) | 5.4 (4.2) | 0.855 |
| ≤ 5 | 82 (68.3) | 9 (52.9) | 73 (70.9) | 0.141 |
| > 5 | 38 (31.7) | 8 (47.1) | 30 (29.1) | |
| Defect closure | 135 (70.3) | 13 (24.5) | 122 (87.8) | < 0.001 |
| Mesh graft | 109 (56.8) | 8 (15.1) | 101 (72.7) | < 0.001 |
| Flap | 27 (14.1) | 1 (1.9) | 26 (18.7) | 0.003 |
| Amputationd | 46 (24.0) | 17 (32.1) | 29 (20.9) | 0.104 |
| Secondary healing | 37 (19.3) | 6 (11.3) | 31 (22.3) | 0.085 |
| HBOT | ||||
| No, not indicated | 98 (51.1) | 24 (45.3) | 74 (53.2) | 0.022 |
| Yes | 83 (43.2) | 22 (41.5) | 61 (43.9) | |
| No, ineligiblee | 11 (5.7) | 7 (13.2) | 4 (2.9) | |
| Antibiotic therapy | ||||
| Number of AB, mean (SD) | 4.6 (2.2) | 4.3 (2.2) | 4.8 (2.2) | 0.153 |
| ≤ 3 | 67 (34.9) | 24 (45.3) | 43 (30.9) | 0.062 |
| > 3 | 125 (65.1) | 29 (54.7) | 96 (69.1) | |
| AB groups, mean (SD) | 3.3 (1.3) | 3.3 (1.5) | 3.3 (1.3) | 0.885 |
| ≤ 3 | 110 (57.3) | 29 (54.7) | 81 (58.3) | 0.656 |
| > 3 | 82 (42.7) | 24 (45.3) | 58 (41.7) | |
| Changes of AB, mean (SD) | 2.5 (2.1) | 2.0 (2.0) | 2.7 (2.0) | 0.007 |
| ≤ 2 | 115 (59.9) | 37 (69.8) | 78 (56.1) | 0.083 |
| > 2 | 77 (40.1) | 16 (30.2) | 61 (43.9) | |
| Hospital treatment | ||||
| ICU treatment | 172 (89.6) | 52 (98.1) | 120 (86.3) | 0.017 |
| Days in ICU, mean (SD) | 13.3 (16.1) | 13.4 (16.8) | 13.2 (16.0) | 0.815 |
| 0 days | 20 (10.4) | 1 (1.9) | 19 (13.7) | 0.012 |
| 1–7 days | 82 (42.7) | 30 (56.6) | 52 (37.4) | |
| > 7 days | 90 (46.9) | 22 (41.5) | 68 (48.9) | |
| Days in hospital, mean (SD)f | 40.2 (26.3) | 22.8 (25.1) | 46.8 (23.7) | < 0.001 |
| ≤ 40 days | 109 (56.8) | 40 (75.5) | 69 (49.6) | 0.001 |
| > 40 days | 83 (43.2) | 13 (24.5) | 70 (50.4) | |
| Complications | ||||
| Total | 120 (63.5) | 47 (92.2) | 73 (52.9) | < 0.001 |
| Infectionsg | 95 (49.5) | 25 (47.2) | 70 (50.4) | 0.693 |
| Sepsis/organ dysfunctionh | 76 (39.6) | 45 (84.9) | 31 (22.3) | < 0.001 |
| Impaired wound healing | 46 (24.0) | 5 (9.4) | 41 (29.5) | 0.004 |
| Prolonged delirium | 30 (15.6) | 4 (7.5) | 26 (18.7) | 0.057 |
| Stump complications | 14 (7.3) | 2 (3.8) | 12 (8.6) | 0.247 |
| Decubitus | 9 (4.7) | 1 (1.9) | 8 (5.8) | 0.257 |
| Thrombosis | 9 (4.7) | 2 (3.8) | 7(5.0) | 0.711 |
| Anus praeteri, j | 29 (15.1) | 5 (9.4) | 24 (17.3) | 0.259 |
| Ileusi | 4 (2.1) | 2 (3.8) | 2 (1.4) | 0.306 |
| Strokei | 3 (1.6) | 1 (1.9) | 2 (1.4) | 1.000 |
| Cardiac arresti | 3 (1.6) | 2 (3.8) | 1 (0.7) | 0.185 |
| Other complicationsi, k | 11 (5.7) | 5 (9.4) | 6 (4.3) | 0.180 |
For calculation of percentages, the number of patients in each column (i.e., in the total cohort and in subgroups with and without mortality) was set to 100%
AB antibiotics, debrid. Debridement, HBOT hyperbaric oxygen therapy, ICU intensive care unit, SD standard deviation, VAC vacuum-assisted closure
aCharacteristics of subgroups with and without mortality were compared with Chi-squared test for categorical variables and with Mann–Whitney-U test for continuous variables. Significant differences are highlighted in bold
bDebridements included both radical debridements and minor surgical debridements for wound conditioning performed in our hospital and/or in other hospitals or departments prior to admission to our center
cTime to first debridement was calculated from the time of admission to our clinic until debridement
dIn the subgroup with amputation, n = 2 patients (1.0%) obtained a minor amputation, n = 3 (1.6%) a transtibial amputation, n = 3 (1.6%) a knee disarticulation, n = 34 (17.7%) a transfemoral amputation, n = 5 (1.6%) a hip disarticulation and n = 8 (4.2%) an atypical amputation. 18 patients (9.4%) had a reamputation
en = 11 patients were ineligible for HBOT due to factors specified in Additional file 1: Table S1
fDefined as number of days from admission to our or to an external hospital until discharge from our hospital or death
gInfections comprised externally acquired and nosocomial urinary tract infections (n = 63), Clostridium difficile infections (n = 28), pneumonia (n = 9), wound infections (n = 3) and catheter sepsis (n = 23)
hThe category "sepsis/organ dysfunction" contained patients with sepsis and/or subsequent renal failure and/or failure of additional organs
iExact Fisher-t-test
jIn 29 patients (n = 14 with necrotizing fasciitis and n = 15 with Fournier’s gangrene), colostomy was performed prior to admission to our department
kOther complications comprised acute coronary syndrome (n = 1), gastrointestinal bleeding (n = 3), requirement of resuscitation (n = 2), tumor progression (n = 1), hypoxic brain damage (n = 1), hematuria (n = 1), stoma complications (n = 1) and biliary stent occlusion (n = 1)