Fournier's Gangrene: population based epidemiology and outcomes.
OBJECTIVE
Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene.


METHODS
We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated.


RESULTS
We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean +/- SD 0.6 +/- 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively.


CONCLUSIONS
Patients with Fournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers.
Sorensen
Mathew D
MD
Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Krieger
John N
JN
Rivara
Frederick P
FP
Broghammer
Joshua A
JA
Klein
Matthew B
MB
Mack
Christopher D
CD
Wessells
Hunter
H
D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003646:Debridement / Q000379:methods; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005832:Genital Diseases, Male / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014861:Washington / Q000453:epidemiology
D000900:Anti-Bacterial Agents