Revisiting Fournier Gangrene: A Contemporary Epidemiological Perspective vs Perineal Cellulitis

Abstract

Introduction: We conducted a population-based analysis of Fournier gangrene (FG) to compare risk factors and mortality with those of perineal cellulitis.

Methods: We analyzed National Inpatient Sample data (2016-2020) to identify FG and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors of FG diagnosis and mortality.

Results: A total of 73,472 cellulitis and 9326 FG cases were identified corresponding to 74,905 (range, 63,050-79,165) and 9115 (range, 7925-11,080) median yearly weighted cases, respectively. FG diagnosis vs cellulitis was positively associated with Native American race (odds ratio [OR], 1.46; 95% CI, 1.19-1.79), weekend (OR, 1.12; 95% CI, 1.06-1.18) or December (OR, 1.33; 95% CI, 1.22-1.44) admissions, diabetes mellitus (OR, 2.51; 95% CI, 2.38-2.64), and malignancy (OR, 2.29; 95% CI, 2.07-2.54). Conversely, Hispanic (OR, 0.79; 95% CI, 0.74-0.85) and Asian/Pacific Islander races (OR, 0.83; 95% CI, 0.69-0.99) and the highest household income quartile (OR, 0.84; 95% CI, 0.78-0.90) were linked to a reduced likelihood of FG diagnosis. Elevated mortality risks were observed with female sex (OR, 1.33; 95% CI, 1.08-1.63), Native American ethnicity (OR, 2.29; 95% CI, 1.14-4.57), and procedural frequency (OR, 1.27; 95% CI, 1.24-1.3) among FG cases.

Conclusions: Various patient and clinical factors are linked to the development and mortality of FG compared with perineal cellulitis. Improved access to care and understanding of FG can enhance patient outcomes.

Keywords: Fournier gangrene; cellulitis; necrotizing fasciitis; orchiectomy; soft-tissue infection.