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Reconstructive and Paediatric Urology
Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases
Article first published online: 21 JUN 2012
DOI: 10.1111/j.1464-410X.2012.11291.x
© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL
Additional Information
How to Cite
Sugihara, T., Yasunaga, H., Horiguchi, H., Fujimura, T., Ohe, K., Matsuda, S., Fushimi, K. and Homma, Y. (2012), Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases. BJU International, 110: E1096–E1100. doi: 10.1111/j.1464-410X.2012.11291.x
Publication History
- Issue published online: 21 DEC 2012
- Article first published online: 21 JUN 2012
- Accepted for publication 23 March 2012
- Abstract
- Article
- References
- Cited By
Keywords:
- bacterial infections;
- epidemiology;
- Fournier's Gangrene;
- mortality;
- fasciitis;
- necrotizing
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.