Fournier's Gangrene: A Modern Analysis of Predictors of Outcomes

Jeffrey D. Sparenborg; Jacob A. Brems; Andrew M. Wood; Jonathan J. Hwang; Krishnan Venkatesan

Disclosures

Transl Androl Urol. 2019;8(4):374-378. 

In This Article

Methods

Hospital medical records were queried for diagnosis codes corresponding to FG and scrotal cellulitis. The medical records of 42 patients treated for FG at Washington Hospital Center in Washington, DC between 2001 and 2015 were identified and reviewed. Operative notes were reviewed for deliberate mention of necrotizing fasciitis or Fournier's to confirm FG. All patients received perioperative fluid resuscitation, as well as broad spectrum antibiotic coverage pending culture results. Standard initial antibiotics within our institution include vancomycin and piperacillin-tazobactam. Use of vasopressor support was based on shared decision of the critical care, urology, and anesthesia teams. Data tabulated from the medical records included vital signs at admission, serum sodium, potassium, creatinine, hematocrit, WBC, bicarbonate. An FGSI score as described by Laor et al. was calculated for 38 of the 42 patients. Four patients were excluded due to incomplete lab results.[9] Additional data seen in Table 1 including length of stay (LOS), number of operations performed during the single admission, mortality, and number of comorbidities were collected as additional prognostic factors to test.

Logistic regression analysis was performed using SAS statistical software (SAS, NC, USA) to investigate whether FGSI predicts mortality. Pearson correlation coefficients were calculated to analyze the relationship between individual variables (e.g., serum Cr, hematocrit, LOS, number of operations, comorbidities) and FGSI score. Receiver operating characteristic (ROC) curve was calculated based on Mann-Whitney testing of the relationship between mortality and FGSI. Odds ratio estimates were calculated to assess risk of mortality with each FGSI score.

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