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

Abstract

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 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.

Conclusion: • Early (≤ 2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3-5 hospital days) action.