Outcome analysis in patients with Fournier's gangrene: report of 45 cases

Abstract

Introduction: Despite antibiotics and aggressive debridement, the mortality rate of Fournier's gangrene remains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking.

Methods: The medical records of 45 patients with Fournier's gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Univariate analysis was performed using the chi-squared test and Fisher's exact probability test, then multivariate analysis of statistically significant variables was performed using logistic regression.

Results: The most prominent associated disease was diabetes, affecting 55.6 percent of the patients. The overall mortality rate was 20 percent. However, the mortality rate among diabetics was 36 percent (P = 0.002). The other statistically significant predictors of outcome were the interval from the onset of symptoms to the initial surgical intervention (P = 0.001) and the need of fecal diversion (P = 0.009). Multivariate regression analysis disclosed that the interval from the onset of symptoms to the initial surgical intervention and diabetes were independent predictors of mortality (P = 0.001 and P = 0.003, respectively).

Conclusion: The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Given the significantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic efforts, Fournier's gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management.