7-year outcomes of regionalized care for Fournier's gangrene at a tertiary care center
Martus Gn, MD1, Rebecca Ortiz, BA2, Christopher Tucci, MS3, Kennon Miller, MD1, Madeline Cancian, MD1.
1The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA, 3Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA.
BACKGROUND: Fournier's gangrene (FG) is a necrotizing fasciitis affecting the genitalia or perineum. Due to the rarity of this disease and frequent need for multidisciplinary care, it has been suggested that regionalized care would improve patient outcomes. However, FG is a surgical emergency requiring expeditious surgical debridement and there is a paucity of data regarding the outcomes of patients transferred for management of this disease. Herein, we report on our experience with regionalized care for FG over a 7-year period and investigate the outcomes of patients who were transferred to our facility.
METHODS: We performed a retrospective review of patients treated for FG at our tertiary care center from 2015 through 2021. Patients who underwent operative debridement and had evidence of a necrotizing soft tissue infection involving the genitalia or perineum were included. Patients were grouped based on transfer status. The primary outcome measure was mortality rate at 30- and 90-days. Secondary outcome measures included length of hospital stay, number of operative debridements, postoperative ICU admission, postoperative mechanical ventilation, and postoperative vasopressor requirement. Chi-squared tests and t-tests were used for statistical analysis and a p value of 0.05 was considered as statistically significant.
RESULTS: A total of 136 patients were treated for FG at our center. 106 (77.9%) were male and 30 (22.1%) were female. Overall 30-day and 90-day mortality rates were equivalent at 5.1%. 33.8% of patients directly presented to our tertiary care center and 66.2% were transferred from outside facilities. Patients transferred from outside facilities did not have an increased risk of mortality (5.6% vs 4.3%; p=0.76), length of hospital stay (mean 14.4±14.5 days vs 13.3±10.5 days; p=0.65) or number of operative debridements (1.83 vs 1.70; p=0.51). There were no differences in rates of postoperative ICU admission (72.2% vs 67.4%; p=0.80), mechanical ventilation (44.4% vs 47.8%; p=0.71), or vasopressor requirement (43.4% vs 52.2%; p=0.33).
CONCLUSIONS: Regionalized care is a safe and effective means for managing FG. Patients transferred from outside facilities did not have lower mortality rates or inferior outcomes compared to patients who presented directly to our center.
|30-day mortality||7 (5.1%)||2 (4.3%)||5 (5.6%)||0.76|
|90-day mortality||7 (5.1%)||2 (4.3%)||5 (5.6%)||0.76|
|Length of stay, mean||16.7 days||13.3 days||14.4 days||0.65|
|Number of debridements||1.79||1.70||1.83||0.51|
|ICU admission||96 (70.6%)||31 (67.4%)||65 (72.2%)||0.80|
|Mechanical ventilation||62 (45.6%)||22 (47.8%)||40 (44.4%)||0.71|
|Postoperative vasopressor||63 (46.3%)||24 (52.2%)||39 (43.3%)||0.33|
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