Necrotising fasciitis in the elderly: comparison between patients aged 60 years and older and those younger than 60 years

Abstract Introduction: Increasing age is associated with an increased incidence of necrotising fasciitis. In this study, we aimed to compare the clinical presentation, investigations, microbiology and clinical outcome in elderly (age ≥60 years) and nonelderly (age <60 years) patients with extremity necrotising fasciitis. Methods: A retrospective review of patients with extremity necrotising fasciitis who were surgically treated between January 2005 and December 2021 was conducted. The following patient outcomes were studied: amputation and mortality rates, length of stay, performance of surgery within 24 h and accuracy of diagnosis at presentation. Results: A total of 167 patients were treated. Of these patients, 66 (39.5%) were aged ≥60 years and 101 (60.5%) were aged <60 years. Elderly patients were more likely to have ischaemic heart disease ( P = 0.001), immunosuppression ( P = 0.019) and bullae ( P = 0.025) on presentation. Significantly more elderly patients had monomicrobial gram-negative infections ( P = 0.006). Elderly patients had significantly higher amputation (42.4% vs. 22.8%, P = 0.01) and mortality (34.8% vs. 18.8%, P = 0.02) rates. Conclusion: In patients aged ≥60 years, necrotising fasciitis of the extremities is associated with significantly increased risk of amputation and mortality. It is important for the treating surgeon to be aware of this association, so that early appropriate empirical antibiotics and radical surgical debridement can be initiated and the patient appropriately counselled.