Loss of Independence following Necrotizing Soft Tissue Infections in Older Adults

Authors:
Manuel Castillo-Angeles, Avery Thompson, Reza Askari

Body of Abstract:
Background: There is a growing shift in benchmarking for older adult care toward metrics that capture outcomes of greatest importance to this cohort. Loss of independence (LOI), which is a composite outcome used to identify patients who are no longer able to live independently post-operatively, has been introduced as a key patient-centered outcome among older adults. However, this hasn’t been fully studied in the necrotizing soft tissue infections (NSTI) population. Our objective was to identify predictors of LOI among NSTI patients.

Methods: The American College of Surgeons National Surgical Quality Improvement Project database (2021-2023) was queried for older adults with a diagnosis of NSTI, which included necrotizing fasciitis, gas gangrene, and Fournier’s gangrene. Our primary outcome was LOI, defined as a decline in functional status, or an increase in care needs (patients discharged to a non-home destination or who needed new support or skilled services at home). Multivariable logistic regression was used to determine factors associated with LOI.

Results: We included 232 older adults with NSTI, mean age was 77.83 (SD 6.14) years, 39.22% were female, and 70.33% were White. 124 (53.45%) experience loss of independence.

After adjusted analysis, significant predictors of LOI were age >=85 years (Odds Ratio [OR] 1.63, 95% Confidence Interval [CI] 1.60–2.09), frailty status (OR 11.17, 95%CI 5.65–16.57), history of dementia or cognitive impairment (OR 5.62, 95%CI 2.43–8.82), and postoperative length of stay (OR 1.21, 95%CI 1.01–1.45).

Conclusions: More than half of older adults with a diagnosis of NSTI experienced loss of independence. LOI could be used as a marker to identify patients who require closer post-discharge monitoring. Further work should focus on targeted interventions that reduce the risk of postoperative LOI in this vulnerable population.