title: Fournier's gangrene: management and mortality predictors in a population based study.
abstract: OBJECTIVE
  The Fournier's gangrene literature comes almost exclusively from tertiary referral centers. We used a population based database to evaluate variations in management and outcomes.
  
  
  METHODS
  Inpatients with Fournier's gangrene who underwent surgical débridement or died were identified from select states in the State Inpatient Databases. Multivariate logistic regression analysis was done to evaluate patient and hospital related predictors of mortality.
  
  
  RESULTS
  We identified 1,641 males with Fournier's gangrene treated at a total of 593 hospitals. At teaching hospitals more Fournier's gangrene cases were treated per year, and more surgical procedures, débridements and supportive care were reported. Patients treated at teaching hospitals had longer length of stay, greater hospital charges and a higher case fatality rate. Patient related predictors of mortality were increasing age (adjusted OR 4.0 to 15.0), Charlson comorbidity index (adjusted OR 1.20 per additional comorbidity), preexisting conditions, ie congestive heart failure (adjusted OR 2.1), renal failure (adjusted OR 3.2) and coagulopathy (adjusted OR 3.4), and hospital admission via transfer (adjusted OR 1.9), after adjusting for hospital factors and Fournier's gangrene experience. Teaching hospitals had higher mortality due primarily to more acutely ill patients (adjusted OR 1.9). Hospitals where more than 1 Fournier's gangrene case per year were treated had 42% to 84% lower mortality after adjusting for patient age, race, Charlson comorbidity index and admission via transfer (p <0.0001).
  
  
  CONCLUSIONS
  Teaching and nonteaching hospitals differ substantially in the populations, case definitions, and severity and management of Fournier's gangrene. Hospitals where more patients with Fournier's gangrene were treated had lower mortality rates, supporting the rationale for regionalized care for this rare disease.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington 98195, USA. mathews@u.washington.edu
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sorensen
authors.forename: John N
authors.initials: JN
authors.lastname: Krieger
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
mesh_terms: D000328:Adult; D000368:Aged; D018934:Fournier Gangrene / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis