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


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 cm(2) 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 cm(2) (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate.


CONCLUSIONS
• Early (≤ 2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3-5 hospital days) action.
Department of Urology, Shintoshi Hospital, Iwata, Japan. ezy04707@nifty.com
Toru
T
Sugihara
Hideo
H
Yasunaga
Hiromasa
H
Horiguchi
Tetsuya
T
Fujimura
Kazuhiko
K
Ohe
Shinya
S
Matsuda
Kiyohide
K
Fushimi
Yukio
Y
Homma
D003646:Debridement / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005832:Genital Diseases, Male / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors