Introduction

Fournier's gangrene is a rare necrotizing soft tissue infection requiring emergent surgical debridement that is often morbid, disfiguring, and can be fatal. Mortality rates reported in the literature have historically been as high as 20-40%. However, contemporary series suggest survival rates are improved. Our objective was to determine the patient characteristics, clinical course, and outcomes for patients treated for Fournier's gangrene at three large, urban, academic, tertiary care institutions.

Methods

In this multi-institutional retrospective study, cases of Fournier's gangrene were identified by ICD-9 (608.83) and CPT (11004, 11005, 11006) codes after obtaining institution-specific review board approval. Accurate diagnosis was confirmed on chart review. Data on comorbidities, hospital course, length of stay, and mortality were extracted from the medical record.

Results

A total of 147 men (ages 24-81, median 52 years) treated for Fournier's gangrene between 2006 and 2016 were identified. Sixty-seven percent of these men had diabetes mellitus. Patients underwent an average of 2.5 (range 1-7, median 2) debridements while hospitalized, with an average length of stay of 19 (range 2-96, median 15) days. Fifty-five percent of patients required multidisciplinary surgical management with some combination of urologic, general, plastic, trauma, and colorectal surgeons, with 22% requiring fecal diversion. Seventy-six percent of men were admitted to the ICU, and 59% required mechanical ventilation. Most wounds were managed with wet to dry dressings, though 27% were covered with a wound vac. Inpatient mortality was 7.4%, which is lower than prior small case series and consistent with contemporary population based studies. Diabetics were significantly more likely to undergo more than one debridement than non-diabetics (p=0.009).

Conclusions

Great strides have been made in reducing the mortality rate of Fournier's gangrene, but high percentages of patients require multiple operations, fecal diversion, and multidisciplinary surgical management. Patients with diabetes are more likely to return to the operating room for repeat debridements. These findings offer insight into contemporary outcomes for men affected by this devastating condition.

Funding

none