Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high‐risk Fournier's gangrene patients

Abstract

Objectives To determine the optimal surgical timing in high‐risk patients with Fournier's gangrene by the Simplified Fournier's Gangrene Severity Index. Methods From 1989 to 2018, 118 male patients diagnosed with Fournier's gangrene with complete medical records were retrospectively reviewed. Patients’ demographics, laboratory parameters at initial diagnosis, Fournier's Gangrene Severity Index and Simplified Fournier's Gangrene Severity Index, and the time interval from emergency room arrival to surgical intervention were collected. The Fournier's gangrene patients were categorized into low‐risk (Simplified Fournier's Gangrene Severity Index ≤2) and high‐risk groups (Simplified Fournier's Gangrene Severity Index >2). Differences between the variables within the two groups were analyzed. The optimal surgical timing was analyzed with the receiver operating characteristic curve in high‐risk Fournier's gangrene patients. Results The overall mortality of 118 Fournier's gangrene patients was 14.4%. After risk stratification with the Simplified Fournier's Gangrene Severity Index scoring system, the mortality of low‐risk and high‐risk Fournier's gangrene patients was 1.3% and 41.0%, respectively. In the high‐risk group, the time interval from emergency room arrival to surgical intervention was the only variable with a significant difference between survivors and non‐survivors (P = 0.039). The optimal surgical timing was determined at 14.35 h, which allowed the highest sensitivity (0.688) and specificity (0.762) to affect mortality. The mortality was significantly lower in high‐risk Fournier's gangrene patients with early surgical intervention compared with late intervention (23.8% vs 68.8%, P = 0.007). Conclusions The Simplified Fournier's Gangrene Severity Index is a quick and reliable screening tool for first‐line physicians to identify high‐risk patients with Fournier's gangrene (Simplified Fournier's Gangrene Severity Index >2) who have poor survival outcomes. We recommended early surgical intervention within 14.35 h to maximize the survival of high‐risk Fournier's gangrene patients.

Técnica De Tunelização Do Testículo Exposto E Importância Do Conhecimento Da Anatomia Na Gangrena De Fournier

“…Bacteróides fragilis e Streptococcus fecalis 13,14,16,17 . A redução da taxa de mortalidade depende do diagnóstico precoce e do início rápido dos tratamentos com antibióticos de amplo espectro 18,19,20,21 , desbridamentos dos tecidos necrosados ,22,23,24,25 e a associação da terapia hiperbárica 26,27,28,29 . A exposição dos testículos poderá determinar a redução da espermatogênese.…”

Location of residence and mortality for patients diagnosed with Fournier’s gangrene

“…18 Surgical debridement within 14.35 hours can reduce mortality by 45% in high risk patients. 3 However, one study demonstrated diagnostic delays up to 12 days due to non-specific complaints and masked presentations, such as simple cutaneous infections, urinary tract infections, and constitutional symptoms. 19 Despite the rapidly progressive infection associated with FG, opportunities for earlier diagnosis and prompt surgical intervention may potentially exist in the non-specific stage of infection.…”

“…1 Despite advancements in medical technology, mortality rates remain high at 3.5% -45%. 2,3 Although multiple factors influence mortality, early surgical intervention appears to be the most important factor with the greatest impact on clinical outcomes, followed by antibiotics and adequate resuscitation. 3,4,5,6 Late presentation to a treatment center causes extensive anatomical and physiological damage in patients, leading to poor outcomes .…”

“…2,3 Although multiple factors influence mortality, early surgical intervention appears to be the most important factor with the greatest impact on clinical outcomes, followed by antibiotics and adequate resuscitation. 3,4,5,6 Late presentation to a treatment center causes extensive anatomical and physiological damage in patients, leading to poor outcomes . 7 Multiple studies examining optimal time for surgical intervention in FG have reported a range of numbers including 7 days from onset of symptoms, to 2 days from time of admission.…”

Editorial Comment to Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high‐risk Fournier's gangrene patients

“…In this study, Lin et al . evaluated the rationale for utilizing the quick Simplified FG Severity Index to identify high‐risk FG clinically and the optimal surgical timing to reduce mortality . They found that the time interval from emergency room arrival to surgical intervention was the only variable with a significant difference between survivors and non‐survivors.…”