Clinical audit of necrotising fasciitis under orthopaedic services in the Bay of Plenty region of New Zealand

Abstract

Background

Necrotising fasciitis is a severe bacterial infection of the soft tissue and fascial layers beneath the skin, with potentially life-threatening consequences. Anecdotal cases of necrotising fasciitis in Tauranga Hospital prompted this study. This study aimed to audit presentations of necrotising fasciitis under orthopaedic services in the Bay of Plenty region over a two-year period.

Methods

All cases of necrotising fasciitis diagnosed in Tauranga and Whakatāne hospitals from April 1, 2021 to March 31, 2023 were identified and obtained using ICD-10 coding data. Descriptive analysis was used to report incidence rates of necrotising fasciitis. The literature was searched to identify global trends in necrotising fasciitis, and explanations for trends were explored.

Results

Five cases of necrotising fasciitis were identified over the study period. All cases were diagnosed during the final five months of the study period, suggesting a sharp increase in incidence. Many body sites were implicated, with some instances of multifocal infection. Implicated sites included the ankle and foot (n = 3), upper arm (n = 2), lower leg (n = 2), pelvis and thigh (n = l), and forearm (n = 1). There was no clear association between age, gender, ethnicity, and location of inhabitancy with rates of necrotising fasciitis.

Conclusion

Necrotising fasciitis is an orthopaedic emergency. Our results demonstrated a sharp increase in its incidence under orthopaedic services in the Bay of Plenty region, which is consistent with broader literature and a cause for concern. Further research is warranted to identify causes and prevention strategies for necrotising fasciitis.