Epidemiology and Early Surgical Intervention in Necrotizing Fasciitis: A Retrospective Cohort Study in Japan

Although previous reports on necrotizing fasciitis have suggested that early initial surgery is associated with a better prognosis, the exact "golden time" for surgery remains undetermined. This single-center, retrospective cohort study included patients with necrotizing fasciitis between December 2011 and December 2023. We described the features of necrotizing fasciitis and evaluated the association between early surgery, mortality, and amputation-free survival in patients with necrotizing fasciitis. A total of 187 patients (median age: 65.5 years; 107 men and 82 women) were included in this study. The microbiological characteristics were generally consistent with those in previous reports from other countries, except for a low prevalence of methicillin resistance among Staphylococcus aureus, a high incidence of Group C or G Streptococci, and the scarcity of Vibrio vulnificus isolation. The mortality was lower in patients undergoing surgery within 0-6 h or 6-12 h compared with those after 12 h (14.6%, 16.1%, and 25.6%, respectively), with an adjusted odds ratio of 0.38 for 0-6 h (95% confidence interval 0.08-1.63) and 0.44 for 6-12 h (95% confidence interval 0.07-2.51). Furthermore, the mortality and/or amputation rate was significantly lower when the time to surgery was 0-6 h or 6-12 h compared with 12 h or more (adjusted odds ratio 0.19 for 0-6 h [95% confidence interval 0.05-0.62], and 0.23 for 6-12 h [95% confidence interval 0.05-0.90]). Our findings suggest that an early surgical intervention, particularly within 6 or 12 h after presentation, is associated with lower mortality and amputation rates in patients with necrotizing fasciitis, emphasizing the importance of prompt treatment for optimal outcomes. Further research is required to determine the optimal timing for surgery.