• Jonathan Jiong Hao Tan, Si Jian Hui, Shawn Jia Hwang Tan, Yiong Huak Chan, Wei Yang Wilson Tham, Joel Yong Hao Tan, Mark Edward Puhaindran, and Choon Chiet Hong.
• Department of Orthopaedic Surgery, National University Health System, Singapore.
• Singapore Med J. 2025 Jan 7.

IntroductionIncreasing 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.MethodsA 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.ResultsA 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.ConclusionIn 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.Copyright © 2025 Singapore Medical Journal.

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