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

Abstract

Introduction: Fournier’s gangrene (FG) is a necrotizing infection of the genitalia. Time from to surgical intervention is a critical determinant of prognosis. We sought to investigate whether patients from rural locations have worse clinical outcomes given distance from a tertiary center.
 Methods: The Manitoba Intensive Care Unit (ICU) registry includes patients who have been admitted into ICUs across Manitoba. We identified patients admitted with FG from February 1999 to October 2019. Age, gender, Charlson comorbidity index (CCI), presence of colostomy and scrotal debridement, length of stay (LOS), and mortality outcomes were obtained. Patients were categorized as being rural or urban.
 Results: From 1999–2019, a total of 79 patients were admitted with FG. The median age was 60 years [interquartile range [IQR] 48–67). The mortality rate during hospitalization was 16.5%. There was no statistically significant difference in the number of deaths for patients from urban vs. rural dwellings (9/47 [19.1%] vs. 4/32 [12.5%], p=0.434]. A comparison of the 66 (83.5%) patients that survived and the 13 (16.5%) that died during ICU hospitalization demonstrated no difference in age, gender, CCI, presence of colostomy, and rates of scrotal re-debridement (p>0.05). Multivariable analysis demonstrated that living in a rural area was not associated with increased mortality (odds ratio 0.64, 95% confidence interval 00.16–2.57, p=0.527).
 Conclusions: Location of residence was not predictive of death from FG. In addition, baseline characteristics such as age, gender, CCI, surgical interventions, or LOS were not found to be associated with mortality.

Predictors of mortality for patients admitted to the intensive care unit with obstructing septic stones

“…This study is in line with our previous findings, in which survival among patients with Fournier's gangrene was similar between rural and urban Manitoba residential locations. [12] On the other hand, in other world regions, it has been shown that there is a disparity in sepsis survival among geographical locations, such as rural Midwestern United States, in which rural hospital bypass is independently associated with increased mortality. [13] The similar survival rates among patients with septic stone in ICUs in Manitoba may be explained by how we defined rural and urban regions, the efficacy of a single-tier healthcare system, geographic, political, or socioeconomic factors that are currently unclear.…”

Neue Aspekte zur Fournierschen Gangrän – Ein Rapid Review

“…Bei den retrospektiven Untersuchungen handelt es sich um 11 Fallserien mit insgesamt 860 FG Patienten [24][25][26][27][28][29][30][32][33][34][35] sowie eine retrospektive Kohortenanalyse mit epidemiologi-that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure.…”

“…Dabei kommen die Autoren zu dem Ergebnis, dass die VAC zwar eine effektive Me-BMI = Body Mass Index; FG = Fourniersches Gangrän; FGSI = Fournier´s Gangrene Severity Index; HBO = hyperbare Oxygenierung; HR = Hazard Ratio; KI = Konfidenzintervall; OR = Odds Ratio; UFGSI = Uludag FGSI; VAC = vakuum-assistierter Wundverschluss thode, aber nicht effektiver als eine konventionelle Wundbehandlung ist[39]. hin Optimierungsbedarf gibt[24,29,30,[33][34][35].Radcliffe et al konnten sogar zeigen, dass sich die Mortalitätsrate in den letzten 25 Jahren nicht signifikant geändert hat und bei etwa 19,8 % liegt [33]. Dies stimmt mit den Ergebnissen von Kranz et al aus dem Jahre 2018 überein.…”