Fournier's Gangrene: Epidemiology and Outcomes in the General US Population

Abstract

Purpose: Case series reported 20-40% mortality rates for patients with Fournier's gangrene with some series as high as 88%. This literature comes almost exclusively from referral centers. Materials and Methods: We identified and analyzed inpatients with Fournier's gangrene who had a surgical debridement or died in the US State Inpatient Databases. Results: One thousand six hundred and forty one males and 39 females with Fournier's gangrene represented <0.02% of hospital admissions. Overall, the incidence was 1.6 cases per 100,000 males and case fatality was 7.5%. Sixty six percent of hospitals cared for no cases per year, 17% cared for 1 case per year, 10% cared for 2 cases per year, 4% cared for 3 cases per year, 1% cared for 4 cases per year, and only 1% cared for ≥5 cases per year. Teaching hospitals had higher mortality (adjusted OR 1.9) due primarily to more acutely ill patients. Hospitals treating more than 1 Fournier's gangrene case per year had an adjusted 42-84% lower mortality (p < 0.0001). Conclusions: Most hospitals rarely care for Fournier's gangrene patients. The population-based mortality rate (7.5%) was substantially lower than the case series from tertiary care centers. Hospitals that treated more number of Fournier's gangrene patients had lower mortality rates, thereby supporting the rationale that regionalized care worked well for patients with this rare disease.