Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Osbun, Nathan; Hampson, Lindsay A.; Holt, Sarah K.; Gore, John L.; Wessells, Hunter; Voelzke, Bryan B.

doi:10.1016/j.jamcollsurg.2016.11.012

Cited by 24 publications

(25 citation statements)

References 20 publications

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“…Table compares our present results to the aggregate results from the literature . We see that our mortality is consistent with the mortality extracted from the literature, despite our patients being on average slightly older.…”

Section: Resultssupporting

confidence: 88%

“…Seven of the 11 patients were known to have diabetes, with one more being diagnosed with diabetes shortly after discharge. Table 1 compares our present results to the aggregate results from the literature [2,[4][5][6]. We see that our mortality is consistent with the mortality extracted from the literature, despite our patients being on average slightly older.…”

Section: Our Case Seriessupporting

confidence: 83%

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Mortality associated with Fournier’s gangrene remains unchanged over 25 years

Radcliffe

Khan

2020

BJU International

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Objectives To report a case series of Fournier’s gangrene (FG) from our institution, and to investigate its mortality over the past 25 years. Patients and Methods Case notes of men presenting to our institution from 2013 to 2016 with FG were reviewed. As well as age, diabetic history, length of stay, length of stay in critical care, and mortality; we calculated (where possible) the Uludag Fournier’s Gangrene Severity Index (UFGSI). Published studies and cases series reporting the mortality rates for FG were reviewed from 1993 to 2018. The size of the study, country of origin, average age and gender ratio were collected, alongside mortality. Results Two of the 11 patients treated for FG at out institution died within 90 days of admission, a mortality rate of 18%. Predicted mortality was significantly higher. A total of 173 publications were identified from the Medical Literature Analysis and Retrieval System Online (MEDLINE) database published between 1993 and 2018, reporting data from 1975 to 2018. Analysis of heterogeneity, by both time and precision, supported exclusion of four retrospective coded database‐driven studies from the analysis. From the remaining studies, mortality ranged from 0% to 42%. Of the 6152 reported cases, there were 1220 deaths, giving an overall mortality rate of 19.8%. There was no evidence of a significant change in the mortality rate for FG over time (P = 0.996). Conclusions In our case series, the mortality rate for FG was 18%, despite a higher predicated mortality (based on UFGSI scores). The treatment of FG remains appropriate resuscitation, aggressive surgical debridement, and critical care management. Perceived high risk of mortality should not deter aggressive management. Mortality due to FG does not appear to have changed over the past 25 years, and is estimated at 19.8%. In studies identifying cases of FG, careful attention should be paid to case definition, particularly when cases are being abstracted retrospectively from large coded databases.

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Section: Resultssupporting

confidence: 88%

Section: Our Case Seriessupporting

confidence: 83%

Mortality associated with Fournier’s gangrene remains unchanged over 25 years

Radcliffe

Khan

2020

BJU International

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“…It is known that a delay of 24 h in the initial surgical treatment may lead to a tenfold greater mortality rate [3,4]. Experience is an additional important factor affecting mortality in the treatment of patients with Fournier's gangrene: seeing more than 1 patient per year had an adjusted 42-84% lower mortality rate (p < 0.0001) [15,16]. Another key point for improving patient outcome is the immediate start of treatment with a broad antibiotic [2,18] and intensive care therapy [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Significance of Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Comparative Study

et al. 2018

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Introduction: Hyperbaric oxygenation (HBO), in addition to anti-infective and surgical therapy, seems to be a key treatment point for Fournier’s gangrene. The aim of this study was to investigate the influence of HBO therapy on the outcome and prognosis of Fournier’s gangrene. Patients and Methods: In the present multicenter, retrospective observational study, we evaluated the data of approximately 62 patients diagnosed with Fournier’s gangrene between 2007 and 2017. For comparison, 2 groups were distinguished: patients without HBO therapy (group A, n = 45) and patients with HBO therapy (group B, n = 17). The analysis included sex, age, comorbidities, clinical symptoms, laboratory and microbiological data, debridement frequency, wound dressing, antibiotic use, outcome and prognosis. The statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA). Results: Demographic data showed no significant differences. The laboratory parameters C-reactive protein and urea were significantly higher in group B (group B: 301.7 vs. 140.6 mg/dL; group A: 124.8 vs. 54.7 mg/dL). Sepsis criteria were fulfilled in 77.8 and 100% of the patients in groups A and B respectively. Treatment in the intensive care unit (ICU) was therefore indicated in 69% of the patients in group A and 100% of the patients in group B. The mean ICU stay was 9 and 32 days for patients in groups A and B respectively. The wound debridement frequency and hospitalization stay were significantly greater in group B (13 vs. 5 debridement and 40 vs. 22 days). Initial antibiosis was test validated in 80% of the patients in group A and 76.5% of the patients in group B. Mortality was 0% in group B and 4.4% in the group A. Conclusion: The positive influence of HBO on the treatment of Fournier’s gangrene can be estimated only from the available data. Despite poorer baseline findings with comparable risk factors, mortality was 0% in the HBO group. The analysis of a larger patient cohort is desirable to increase the significance of the results.

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“…Fournier's gangrene (FG) is a very rare, life-threatening, necrotizing infection affecting the perineum, perineal region and genitals [ 1 , 2 ]. As it occurs so seldom, most of the limited knowledge about FG arises from retrospective single-institutional studies with very small patient cohorts [ 3 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, FG also has a poor prognosis. Early studies of FG reported a 20 to 88% mortality rate [ 1 ; 16 – 18 ], but two studies from 2017 calculated a mortality rate of 25 to 26% [ 2 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Desperate need for better management of Fournier's Gangrene

Kranz

Schlager

Anheuser

et al. 2018

Cent european J Uro

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IntroductionTo compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates.Material and methodsA multicentric, retrospective, multi-national study was performed. Two groups with different time frames of treatment were defined: Group 1 (n = 50) and Group 2 (n = 104). Demographics and outcomes were analysed using Student-t test, chi-square test, or Fisher exact test. Survival data were estimated using the Kaplan Meier method and compared by Log rank testing.ResultsThere were no significant demographic differences. Nor was there any significant difference in therapy or outcomes in the groups except for the duration of intensive care unit treatment, which lasted a mean 6.3 days in Group 1 and 11.5 days in Group 2 (p = 0.018). Survival time did not improve over the years (p = 0.268). We fortunately did not observe an increased rate of multi-resistant organisms (p = 1.000). This study's limitations are mainly due to its retrospective study design.ConclusionsDespite increasing antibiotic resistance rates worldwide, it was not apparent in our population. But the situation for these patients is alarming, since final outcome failed to improve over the last ten years despite more intensive critical-care therapy.

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Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Cited by 24 publications

References 20 publications

Mortality associated with Fournier’s gangrene remains unchanged over 25 years

Mortality associated with Fournier’s gangrene remains unchanged over 25 years

Significance of Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Comparative Study

Desperate need for better management of Fournier's Gangrene

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