---
title: "Pretransport Surgery for Necrotizing Soft Tissue Infections: Impact on Mortality, LOS, and Charges"
id: "pubmed-42684069"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42684069"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42684069/"
doi: "10.1002/wjs.70546"
published_at: "2026-09-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pretransport Surgery for Necrotizing Soft Tissue Infections: Impact on Mortality, LOS, and Charges
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42684069
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42684069/)
- **DOI:** [10.1002/wjs.70546](https://doi.org/10.1002%2Fwjs.70546)
- **Published At:** 2026-09-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This multicenter administrative-database analysis examined outcomes for **necrotizing soft tissue infection (NSTI)** patients transferred between hospitals, focusing on whether patients had an operation before transfer (PRE). - Data came from HCUP State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for Massachusetts, Wisconsin, and Colorado for 2022. - The cohort included 243 transferred NSTI patients; mean age was 56.7 years (SD 14.5) and 30.5% were female. - Patients originated from 127 referring hospitals and were sent to 52 receiving centers, with wide variation in referring center volumes and PRE rates. - Seventy-seven patients (31.7%) underwent a **pre-transfer operation**. Rates of severe sepsis or septic shock were similar between PRE and non-PRE patients (41.6% vs. 37.4%, p = 0.531). - Crude mortality was 9.1% for PRE patients (7/77) and 6.0% for non-PRE patients (10/166); multivariable analysis yielded an adjusted odds ratio (aOR) of 1.62 for PRE versus non-PRE (p = 0.38), indicating no statistically significant mortality difference. - PRE patients experienced longer hospital stays both before transfer (median 4 vs. 0 days, p < 0.001) and after transfer (median 15 vs. 10 days, p = 0.01). - Healthcare charges were higher for PRE patients both before transfer (median $66,214.50 vs. $11,227.50, p < 0.001) and after transfer (median $161,615 vs. $89,728, p = 0.012). - Authors conclude that **pre-transfer debridement** was not associated with lower mortality among transferred NSTI patients and was associated with longer LOS and higher charges, possibly reflecting worse physiology or more complex wounds among PRE patients. - Study limitations (data source and observational design) and further granular clinical details were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Interhospital Transfer Patients With Necrotizing Soft Tissue Infections: An Evaluation of the Role for Pretransport Operation [Hans V Strobl](https://pubmed.ncbi.nlm.nih.gov/?term=Strobl+HV&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Diane N Haddad](https://pubmed.ncbi.nlm.nih.gov/?term=Haddad+DN&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Renee Bicaba](https://pubmed.ncbi.nlm.nih.gov/?term=Bicaba+R&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Renee I Tristano](https://pubmed.ncbi.nlm.nih.gov/?term=Tristano+RI&cauthor_id=42684069)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-2 "Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA."), [Phillip M Dowzicky](https://pubmed.ncbi.nlm.nih.gov/?term=Dowzicky+PM&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Abid D Khan](https://pubmed.ncbi.nlm.nih.gov/?term=Khan+AD&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Timothy P Plackett](https://pubmed.ncbi.nlm.nih.gov/?term=Plackett+TP&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Justin S Hatchimonji](https://pubmed.ncbi.nlm.nih.gov/?term=Hatchimonji+JS&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#full-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA.") Affiliations Expand ### Affiliations * 1 Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA. * 2 Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA. * PMID: **42684069** * DOI: [ 10.1002/wjs.70546 ](https://doi.org/10.1002/wjs.70546) Item in Clipboard # Interhospital Transfer Patients With Necrotizing Soft Tissue Infections: An Evaluation of the Role for Pretransport Operation Hans V Strobl et al. World J Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID World J Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22World+J+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22World+J+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42684069/) . 2026 Sep 2. doi: 10.1002/wjs.70546. Online ahead of print. ### Authors [Hans V Strobl](https://pubmed.ncbi.nlm.nih.gov/?term=Strobl+HV&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Diane N Haddad](https://pubmed.ncbi.nlm.nih.gov/?term=Haddad+DN&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Renee Bicaba](https://pubmed.ncbi.nlm.nih.gov/?term=Bicaba+R&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Renee I Tristano](https://pubmed.ncbi.nlm.nih.gov/?term=Tristano+RI&cauthor_id=42684069)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-2 "Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA."), [Phillip M Dowzicky](https://pubmed.ncbi.nlm.nih.gov/?term=Dowzicky+PM&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Abid D Khan](https://pubmed.ncbi.nlm.nih.gov/?term=Khan+AD&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Timothy P Plackett](https://pubmed.ncbi.nlm.nih.gov/?term=Plackett+TP&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA."), [Justin S Hatchimonji](https://pubmed.ncbi.nlm.nih.gov/?term=Hatchimonji+JS&cauthor_id=42684069)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42684069/#short-view-affiliation-1 "Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA.") ### Affiliations * 1 Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois, USA. * 2 Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA. * PMID: **42684069** * DOI: [ 10.1002/wjs.70546 ](https://doi.org/10.1002/wjs.70546) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Early debridement is the cornerstone of treatment for necrotizing soft tissue infections (NSTI), but patients are frequently transferred for management. We described practice patterns, hypothesizing that pre-transfer NSTI debridement is associated with improved outcomes. **Methods:** We analyzed data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for Massachusetts, Wisconsin, and Colorado in 2022. NSTI patients and the subset undergoing operation before transfer (PRE) were identified. The primary outcome was mortality. We performed multivariable logistic regression adjusting for demographics, weekend transfer, severe sepsis or septic shock, and Charlson comorbidity index (CCI). Secondary outcomes were length of stay (LOS) and hospital charges. **Results:** We identified 243 transferred NSTI patients. Mean age (SD) was 56.7 (14.5) years, and 74 (30.5%) were female. There were 127 referring and 52 receiving centers, with a wide range of case volume and PRE rates. Seventy-seven (31.7%) patients were PRE; there was no difference in rates of sepsis between these patients and the remainder (41.6% vs. 37.4%, p = 0.531). Mortality with and without pre-transfer operation was 7/77 (9.1%) versus 10/166 (6.0%), with aOR = 1.62 for PRE, (p = 0.38). Pre- and post-transfer median LOS were longer for PRE (4 vs. 0 days at the referring hospital, p . 4. 1. D. A. Anaya, K. McMahon, A. B. Nathens, S. R. Sullivan, H. Foy, and E. Bulger, “Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections,” Archives of Surgery 140, no. 2 (2005): 151–157, . 5. 1. T. W. Hakkarainen, N. M. Kopari, T. N. Pham, and H. L. Evans, “Necrotizing Soft Tissue Infections: Review and Current Concepts in Treatment, Systems of Care, and Outcomes,” Current Problems in Surgery 51, no. 8 (2014): 344–362, . 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