Contemporary National Outcomes of Hyperbaric Oxygen Therapy in Necrotizing Soft Tissue Infections

Abstract

Abstract Background: The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small prospective and retrospective studies. A previous study based on the 1998-2009 National Inpatient Sample (NIS) by Soh et al found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. Methods: The 2012-2020 National Inpatient Sample (NIS) was queried for admissions with NSTI including only hospitalized patients who received surgery; 60,481 patients from 2012-2020 were included. Of these, 600 (<1%) underwent HBOT. The primary outcome of interest was in-hospital mortality, while secondary outcomes included amputation, hospital length of stay, and costs. A multivariate model was constructed to account for baseline differences in groups. Results: Age, gender, Elixhauser comorbidity index were similar between the two groups. On bivariate comparison, the HBOT group had lower mortality rate (<2% vs 5.9%, p<0.001) and lower amputation rate (11.8% vs 18.3%, p<0.001) however, longer lengths of stay (16.9 days vs 14.6 days, p<0.001) and higher costs ($54,000 vs $46,000, p<0.001) were observed. Findings persisted after adjustments for potential confounders including sepsis. After multivariate analysis, HBOT was associated with decreased mortality (Adjusted Odds Ratio (AOR) 0.22, 95% CI 0.09-0.53, P<0.001) and lower risk of amputation (AOR 0.73, 95% CI 0.55-0.96, P=0.03). While the HBO group was associated with longer stays by 1.6 days (95% CI 0.4-2.7 days) and increased costs by $7,800 (95% CI $2,200-$13,300), they also had significantly lower risks of non-home discharges (AOR 0.79, 95%CI 0.65-0.96). Conclusions: After correction for differences between groups, HBOT was associated with decreased mortality, amputations, and non-home discharges in NSTI with the tradeoff of modest increase to costs and length of stay.