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Increased Risk for Upper Extremity Amputation in Minority Patients with Necrotizing Fasciitis
Christopher M Dussik, MD
1, Amy Phan, MD
1, Jeffrey Coombs, MD
1, Thomas Carroll, MD
2, Andrew Jae-Min Park, MD
1, Bilal Mahmood, MD
3; Danielle M Wilbur, MD
1(1)University of Rochester Medical Center, Rochester, NY, (2)University of Rochester, Rochester, NY 14642, NY, (3)University of Rochester, Rochester, NY
Introduction: Necrotizing fasciitis of the upper extremity is often a life-altering and life-threatening condition. Surgical outcomes depend on factors including delay in presentation, medical comorbidities, time to diagnosis, and time to treatment. The impact of healthcare disparities among underrepresented populations has been increasingly highlighted across various surgical specialties. The present study sought to evaluate whether racial or ethnic variables influence outcomes after necrotizing fasciitis of the upper extremity on a population-wide basis.
Materials and Methods: The TriNetX database was queried for patients diagnosed with necrotizing fasciitis who received upper extremity surgeries between January 1, 2010, and December 31, 2023. We then evaluated the incidence of formal irrigation and debridement, amputation across upper extremity levels, and mortality within twelve months of diagnosis. Outcomes were stratified based on racial and ethnic demographics. Chi-squared and odds ratio analyses were used to evaluate the significance of trends observed across demographic groups.
Results: We evaluated outcomes for 1,253 patients undergoing upper extremity procedures in the setting of necrotizing fasciitis (Table 1). Among this cohort, 519 patients underwent amputation. Unmatched analyses comparing amputation rates after necrotizing fasciitis revealed increased rates of amputation across minority demographics as a whole compared to non-Hispanic, white patients (Figure 1). Matched analyses showed continued increased rates of amputation across underrepresented populations, as well as among Hispanic patients and Asian/Pacific Islanders. Minority patients were at an increased risk for upper extremity amputation, with an odds ratio of 1.71. After comorbidity matching, this effect was preserved with an odds ratio of 1.60.
Conclusions: Underrepresented patients with necrotizing fasciiitis undergo amputations 60% more frequently than non-Hispanic, White patients. Further investigation into social determinants of health is warranted to achieve parity in outcomes and ensure objectivity in decision-making for these at-risk groups.
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