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Diabetes is Associated with Better Short-Term Survival in Fournier’s Gangrene
Aaron Seto, BA1, Emma Laquinta, BA
1, Kamil Malshy, MD
2, Allegra Rollo, BA
1, Taylor Braunagel, BS, MS
1, Richard Glebocki, BS
1, Borivoj Golijanin, MD
1, Madeline Cancian, MD
1.
1The Minimally Invasive Urology Institute at the Miriam Hospital, Brown University Health, Warren Alpert Medical School of Brown University, Providence, RI, USA,
2University of Rochester Medical Center, Rochester, NY, USA.
BACKGROUND: Fournier’s Gangrene (FG) is a polymicrobial necrotizing infection affecting the perineal and pelvic area. Among risk factors, diabetes is highly prevalent, but its association with FG mortality following surgical debridement remains unclear. This study seeks to describe the influence of diabetes on FG patient mortality after surgical debridement.
METHODS: A retrospective cohort study was conducted on FG patients who underwent surgical debridement at Miriam Hospital from October 2011 to December 2023. Associations between covariates and mortality were evaluated using Cox regression analysis.
RESULTS: Among our 199 FG patient cohort (83% male, 81% white, median age 58 [IQR: 48, 66]), 135 (68%) patients were diabetic on admission, with 11 diagnosed on admission. 110 (55%) patients had available A1C on admission with an average A1C of 8.5. Diabetic patients had higher median Body Mass Index (33.95 vs 30.5, p=.0089) and higher average Charles Comorbidity Index (CCI) points (2.92 vs 4.13, p=.0008) than non-diabetic patients. Over the entire study period, age (HR: 1.0245, p=.036) and CCI (HR: 1.1964, p=.001) were associated with post-debridement mortality while diabetic status had no effect. Within 6 months post-debridement, CCI (HR: 1.2580, p=.018) remained associated with mortality, but diabetes (HR: .3067, p=.013) was associated with lower mortality. Figure 1 shows Kaplan-Meier survival curves comparing diabetic and non-diabetic FG patients over the study period.
CONCLUSIONS: Diabetes was not associated with long-term FG patient mortality following surgical debridement but was associated with lower mortality in the first 6 months. Age and overall comorbidity were stronger predictors of long-term mortality rates, highlighting the need for further investigation into FG pathophysiology and more comprehensive risk assessments for patients.
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