The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

Elsaket, A E; Maharajh, S; Urry, R.J.

doi:10.7196/samj.2018.v108i8.13100

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…Hong et al reported an mortality rate of 60% for fifteen septic Vibrio NSTI patient with all a NSTI affecting the extremities, which was associated with a mean duration of the initial debridement of 102 min [ 5 ]. Corman et al found a mortality rate of 4% for Fournier gangrene with an associated mean duration of the initial surgery of 78 min and Elsaket et al reported an mortality rate of 11.4% for Fournier gangrene associated with a mean duration of the initial debridement of 81 min [ 4 , 6 ]. Notable, all patients underwent a scrotectomy for source control in the study by Corman et al and in the study by Elsaket et al only 5% of the patients were septic upon presentation.…”

Section: Discussionmentioning

confidence: 99%

“…In this review, it was also attempted to identify a relationship between the operative time of the initial surgery for the NSTI and the mortality, the results for this analysis were too scarce. Even though only three studies reported on operative times, these results revealed a possible association between the duration of the initial surgery and the outcome of the NSTI [ 3 – 6 ]. It is well established in trauma and emergency surgery that prolonged operating times potentially lead to higher complication rates [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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The impact of operative time on the outcomes of necrotizing soft tissue infections: a multicenter cohort study

et al. 2022

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Background The primary aim of this study was to identify if there is an association between the operative time of the initial debridement for necrotizing soft tissue infections (NSTIs) and the mortality corrected for disease severity. Methods A retrospective multicenter study was conducted of all patients with NSTIs undergoing surgical debridement. The primary outcome was the 30-day mortality. The secondary outcomes were days until death, length of intensive care unit (ICU) stay, length of hospital stay, number of surgeries within first 30 days, amputations and days until definitive wound closure. Results A total of 160 patients underwent surgery for NSTIs and were eligible for inclusion. Twenty-two patients (14%) died within 30 days and 21 patients (13%) underwent an amputation. The median operative time of the initial debridement was 59 min (IQR 35–90). In a multivariable analyses, corrected for sepsis just prior to the initial surgery, estimated total body surface (TBSA) area affected and the American Society for Anesthesiologists (ASA) classification, a prolonged operative time (per 20 min) was associated with a prolonged ICU (β 1.43, 95% CI 0.46–2.40; p = 0.004) and hospital stay (β 3.25, 95% CI 0.23–6.27; p = 0.035), but not with 30-day mortality. Operative times were significantly prolonged in case of NSTIs of the trunk (p = 0.044), in case of greater estimated TBSA affected (p = 0.006) or if frozen sections and/or Gram stains were assessed intra-operatively (p < 0.001). Conclusions Prolonged initial surgery did not result in a higher mortality rate, possible because of a short duration of surgery in most studied patients. However, a prolonged operative time was associated with a prolonged ICU and hospital stay, regardless of the estimated TBSA affected, presence of sepsis prior to surgery and the ASA classification. As such, keeping operative times as limited as possible might be beneficial for NSTI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of operative time on the outcomes of necrotizing soft tissue infections: a multicenter cohort study

et al. 2022

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“…Patients with diabetes are more likely to develop Fournier's gangrene; however, the overall length of hospital stay and mortality does not appear to be affected. 2,5,10 Diabetes appears to be associated with younger age at presentation 5 and patients may require significantly more debridements than those without diabetes. 10 Patients with poorly controlled diabetes, indicated by a high HbA1c, have been found to require longer hospital stays, larger surface area involvement and higher severity index scores.…”

Section: Diabetesmentioning

confidence: 99%

“…2,5,10 Diabetes appears to be associated with younger age at presentation 5 and patients may require significantly more debridements than those without diabetes. 10 Patients with poorly controlled diabetes, indicated by a high HbA1c, have been found to require longer hospital stays, larger surface area involvement and higher severity index scores. 11 Fungal organisms should be considered in diabetic patients as an important causative pathogen.…”

Section: Diabetesmentioning

confidence: 99%

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The diagnosis and management of Fournier's gangrene

Brown

Coull

2019

Trends Urol & Men's Health

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Understanding cultural and logistical contexts for urologists in low‐income countries

et al. 2022

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The provision of effective urological management in low-and middle-income countries requires the delivery of appropriate and effective care adapted to the needs, capability and resources of the host country. However, a deeper cognisance of the culture, the religious practices and the logistics of healthcare in that environment determines the ability to effectively to 'twin', that is, to provide a long-term healthcare partnership. Patient beliefs can have profound effects on the understanding of the aetiology of illness, its relevance to their long-term health and the stigmatization of their family's social status. Consequently, individuals may have a greater willingness to seek help from practitioners of traditional medicine due to its availability as well as the lower costs of such medicine by comparison to those of medicine from highincome countries (HICs). This can influence the treatment of many urological conditions and lead to late-presenting states such as malignant ureteric obstruction. Social mores, such as cultural paternalism, can also influence many practices that are assumed by HICs to be part of normal healthcare provision, including the delivery of patient information and provision of informed consent to treatment. Doctor's status and dress have greater importance in many countries in sub-Saharan Africa (sSA) than in the UK and the modes of greeting and addressing colleagues and patients can affect the fluency and effectiveness of clinical interactions. A local cultural and religious knowledge is essential, therefore, to optimize the assimilation of external help. Logistics are perhaps the most important factor that needs to be grasped to provide a sustainable healthcare environment. Limitations in resource allocation are a major factor in planning effective urological treatment in many countries in sSA, whether this is the provision of trained personnel, basic infrastructure, a tenable workspace, equipment or drugs. This paper explores all of these factors, and looks at how their recognition assists urologists in providing a twinning process.

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The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

Cited by 12 publications

References 27 publications

The impact of operative time on the outcomes of necrotizing soft tissue infections: a multicenter cohort study

The impact of operative time on the outcomes of necrotizing soft tissue infections: a multicenter cohort study

The diagnosis and management of Fournier's gangrene

Understanding cultural and logistical contexts for urologists in low‐income countries

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