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OBJECTIVE: To evaluate if hyperbaric oxygen therapy (HBO) as an adjunctive treatment of necrotizing soft tissue infections (NSTI) is associated with improved survival.
DESIGN: Retrospective cohort study.
SETTING: Two academic tertiary medical centers: one center used HBO therapy routinely for NSTIs (Sweden) while the other center did not use it (United States).
PATIENTS: Of 134 patients with a diagnosis of NSTI (01/2007-09/2011), 83 Swedish patients received HBO therapy (HBO group) while the remaining 51 U.S. patients underwent traditional management alone (non-HBO group).
MAIN OUTCOME MEASURES: The primary outcome was survival to hospital discharge. Number of debridements and limb salvage were secondary outcomes.
RESULTS: The two groups were similar in demographics, Charlson Comorbidity Index score, physiologic compromise, leukocytosis, and time to surgery. Non-HBO patients had a higher BMI (34 kg/m² vs. 28 kg/m²; p=0.006) and rate of diabetes (51% vs. 27%; p=0.004).

Outcomes	HBO group (N= 83)	Non-HBO group (N= 51)	p-value
Amputations	1 (2%)	7 (19%)	0.005
Debridements	2.5 + 1.8	3.4 + 2.7	0.04
Survival	2 (97.5%)	7 (86%)	0.03

By accounting for differences between the groups, logistic regression identified HBO therapy as an independent predictor of survival (OR: 5.7, 95% CI: 1.1-29.9, p=0.038).
CONCLUSIONS: HBO therapy was associated with improved survival, fewer debridements, and increased rate of limb salvage in patients with NSTI.