Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases

Authors


Toru Sugihara, Department of Urology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. e-mail: ezy04707@nifty.com

Abstract

Study Type – Prognosis (outcome)

Level of Evidence 2b

What's known on the subject? and What does the study add?

Reportedly, Fournier's gangrene has a high mortality rate, ∼7.5–40%, and experts recommend early surgical debridement.

This study examines 379 patients and shows that an early intervention, i.e. within 2 hospital days could halve the mortality rate compared with later intervention.

OBJECTIVE

  • • To examine how early surgical intervention influenced cases of Fournier's gangrene (FG) fatality.

PATIENTS AND METHODS

  • • Patients with FG (defined as an International Classification of Diseases-10 code of M72.6 [necrotizing fasciitis] at the perineum or external genitalia), who received surgical intervention ≤5 days after admission, were identified from the Diagnosis Procedure Combination database for the 6-month period July to December, in the years 2007–2010.
  • • Data included age, sex, comorbidities, ambulance use, operations and debridement ranges.
  • • Multivariate logistic regression analysis of mortality was performed to show whether early (≤2 hospital days) or delayed (3–5 hospital days) surgical treatment affected FG outcomes.

RESULTS

  • • A total of 302 male and 77 female patients with FG were identified for which the overall case fatality rate was 17.1% (65 cases).
  • • There were no significant differences in patient characteristics between the early operation group (n= 327) and the delayed operation group (n= 52), with the exception of ambulance use (33.3% vs 17.3%, P= 0.020).
  • • Cystostomy, colostomy, orchiectomy/penectomy (male patients only), or debridement ≥3000 cm2 were performed on 42 (8.8%), 56 (11.5%), 46 (10.8%) and 17 (4.4%) patients, respectively.
  • • Multivariate analysis showed that there was a significantly lower case fatality rate among the early operation group (odds ratio [OR]= 0.38; P= 0.031).
  • • Older age (OR 1.80, for 10-year increments), Charlson comorbidity index score (OR = 1.33, for 1-point increments), sepsis or disseminated intravascular coagulation at admission (OR 4.01), and debridement range ≥3000 cm2 (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate.

CONCLUSION

  • • Early (≤2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3–5 hospital days) action.

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