Demographic Variations in Amputation Rates for Upper-Extremity Necrotizing Fasciitis.

PURPOSE: Necrotizing fasciitis of the upper extremity is a life-altering and often life-threatening condition. Surgical outcomes depend on factors that include delay in presentation and concurrent medical comorbidities. The impact of health care disparities among underrepresented populations has been increasingly highlighted across various surgical specialties. The present study sought to evaluate whether racial or ethnic variables influence outcomes after necrotizing fasciitis of the upper extremity on a population-wide basis.

METHODS

The TriNetX database was queried for patients diagnosed with necrotizing fasciitis who received upper-extremity surgeries between January 1, 2010, and December 31, 2024. We evaluated the incidence of amputation across upper-extremity levels and mortality within 6 months of diagnosis. Outcomes were stratified based on racial and ethnic demographics. Logistic regression was used to account for potential confounding because of differences in age, biological sex, medical comorbidities, perioperative laboratory values, and preoperative vasopressor use.

RESULTS

We identified 1,396 patients who underwent upper-extremity procedures in the setting of necrotizing fasciitis. After matching, minority patients demonstrated higher odds of undergoing amputation compared with non-Hispanic White patients, with an odds ratio of 1.5 (95% CI, 1.1-2.0). When stratified by specific demographic groups, this disparity persisted among both Hispanic and Asian/Pacific Islander patients.

CONCLUSIONS

Underrepresented patients with necrotizing fasciitis undergo amputations 50% more frequently than non-Hispanic, White patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis II.