Fournier's Gangrene: Population Based Epidemiology and Outcomes

Abstract

Purpose-Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene.Materials and Methods-We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated.Results-We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean ± SD 0.6 ± 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively. Conclusions-Patients withFournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers. Keywordsurology; male; female; gangrene; mortality Fournier's gangrene is a urological emergency characterized by progressive necrotizing infection of the external genitalia or perineum. 1 Most studies indicate a mortality rate of 20% to 40% with some studies showing a fatality rate of as high as 88% (table 1). 2 These data are from tertiary referral centers with the largest series including only 80 patients. 3 The generalizability of these data is limited. Previous reports reflect differences in referral patterns, surgical management, clinical volumes and many other institutional differences.* Correspondence: Department of Urology, University of Washington School of Medicine, 1959 Northeast Pacific St., Box 356510, Seattle, Washington 98195 (telephone: 206-543-3640; FAX: 206-543-3272 For example, reports diverge widely in recommendations for urinary and fecal diversion, hyperbaric oxygen use and early skin grafting. [3][4][5][6][7] There are sparse data from community hospitals and to our knowledge no population based data on incidence, regional trends or case fatality rates.To better understand epidemiology and outcomes in patients with Fournier's gangrene we examined a large, population based database to determine patient characteristics, and the incidence of and hospital experience with Fournier's gangrene. We hypothesized that previous case series from tertiary referral centers do not reflect the clinical spectrum and outcomes in the general population. MATERIALS AND METHODS Popula...

Partial penectomy after debridement of a Fournier's Gangrene progressing with an isolated penile necrosis

“…Mortality rate was reported as 16% in a study including 1726 FG patients. [6][7][8] FG is a polymicrobial process starting with a triggering event. In etiology, both aerobic and anaerobic microorganisms play role.…”

Hyperbaric Oxygen Therapy for the Treatment of Fournier’s Gangrene: A Review of 34 Cases

“…It is a rare disease 2,3 that predominantly affects males (at a 10 to 1 ratio) with an average age of 50 years. 2,4 Several predisposing factors have been identified: diabetes, alcoholism, arterial hypertension, renal and hepatic insufficiency, obesity, dementia, tobacco consumption and diseases that affect the immune system such as human immunodeficiency syndrome (HIV), chemo and radiotherapy, cancer and surgical interventions.…”

Fournier’s Gangrene

“…Early series reported high mortality rates around 80%in one report as high as 88% [21] but more recent studies have lower rates of mortality less than 40%. Barreda et al has reported a mortality rate of 29% in their retrospective case avalysis consisting of 41 patients [10]; on the other hand Sorensen et al has reported the overall case fatality rate was 7.5% in their large retrospective analysis including 1680 patients [3]. One of the most important measures for decreasing mortality and hospital stay is the timing of surgery.…”

“…However the first description is known to be made by Baurienne in 1764 [1,2]. Despite advances in treatment; overall mortality remains high [3][4][5].…”