Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

AbstractBackground: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue in fections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias becauseHBOT is not available universally at all medical centers, and there is often considerable delay associated with itsinitiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers thathave their own HBOT facilities.Methods: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that havetheir own HBOT facilities (n = 14). Cases of NSTI were identified by International Classification of Diseases, NinthRevision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gasgangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedurecode 93.95. Our cohort was risk-stratified and matched by UHC’s validated severity of illness (SOI) score.Comparisons were then made using univariate tests of association and multivariable logistic regression.Results: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT.Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p < 0.01) and fewer deaths (4% vs. 23%; p < 0.01). Multivariable analysis showed that patients who did not receive HBOT were lesslikely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2–25.1).Conclusion: At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.