Female gender and racial minority status is associated with Poor clinical outcomes and higher healthcare resource utilization in necrotizing fasciitis: Analysis of a Nationwide database in the United States

Abstract

Introduction

Necrotizing fasciitis is a rapidly progressive infection associated with high mortality and complications. It mainly involves subcutaneous tissue and fascia. More quality data on disparities in clinical outcomes of necrotizing fasciitis must be provided. Our study aims to identify gender and racial disparities in necrotizing fasciitis outcomes.

Methods

We used data from the Nationwide Inpatient Sample database from 2016 to 2020. As appropriate, the Chi-square and t-test were used to test for associations between categorical and continuous variables. Multivariate logistic regression models, adjusted for key confounders, were used to obtain odds ratios for in-hospital mortality and various complications. Similarly, multivariate linear regression models were created for continuous outcome variables.

Results

Among 118,775 patients with necrotizing fasciitis, women (adjusted odds ratio [aOR] 1.18, 95 ​% confidence interval [CI]: 1.07–1.30, p ​= ​0.001), Asian (aOR 1.49 (95 ​% CI: 1.10–2.02, p ​= ​0.01), and Hispanic (aOR: 1.16; 95 ​% CI: 1.0–1.35; p ​= ​0.045) patients had significantly higher in-hospital mortality than White patients.

In comparison with men, women were more likely to require invasive mechanical ventilation and blood transfusions and develop ARDS. They are less likely to develop AKI, acute myocardial infarction, or venous thromboembolism and require non-invasive mechanical ventilation (p ​< ​0.05 for all comparisons). Similarly, certain racial minority groups were also at a heightened risk for complications, such as AKI requiring hemodialysis, ARDS, venous thromboembolism, sudden cardiac arrest, and need for blood transfusion, among others (p ​< ​0.05 for all comparisons).

As compared to white patients, African American (1.7 days longer, p ​< ​0.001), Asian (4.3 days longer, p ​< ​0.001), and Hispanic (0.6 days longer, p ​= ​0.048) patients had a significantly longer length of hospital stay. Asian, African American, and Hispanic patients also had substantially higher hospitalization costs, amounting to an additional $17,596.07 (p ​< ​0.001), $5899.60 (p ​< ​0.001), and $4356.55 (p ​< ​0.01), respectively, versus White patients. Native American patients did not have any significant difference in the cost of hospitalization as compared to White patients.

Conclusion

Females and racial minorities are at increased risk of mortality and higher healthcare resource utilization in necrotizing fasciitis. There is a need to develop equitable management strategies and health policy interventions to address these disparities effectively.