You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121093 A CONTEMPORARY ANALYSIS OF FOURNIER'S GANGRENE USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM James M. Dupree, Brian V. Le, Dae Y. Kim, Lee C. Zhao, John P. Cashy, and Shilajit D. Kundu James M. DupreeJames M. Dupree Chicago, IL More articles by this author , Brian V. LeBrian V. Le Chicago, IL More articles by this author , Dae Y. KimDae Y. Kim Chicago, IL More articles by this author , Lee C. ZhaoLee C. Zhao Chicago, IL More articles by this author , John P. CashyJohn P. Cashy Chicago, IL More articles by this author , and Shilajit D. KunduShilajit D. Kundu Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditional mortality rates for Fournier's Gangrene (FG) and necrotizing fasciitis of the genitalia (NFG) are approximately 20% but are reported as high as 75%. Unfortunately, these figures are based on small, single institution studies from the 1980s and 1990s. We sought to determine a nationwide, contemporary description of surgical FG/NFG outcomes. METHODS The National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted surgical database used by over 350-hospitals nationwide which tracks preoperative, intraoperative, and 30-day postoperative clinical variables. Data is extracted directly from patient charts by an independent surgical clinical reviewer at each hospital. Using NSQIP data from 2005–2009, we identified surgical patients with a primary or secondary CPT code of 11004 or 11006. We calculated 30-day mortality rates and identified preoperative factors associated with increased mortality. RESULTS 650 patients were identified with surgery for FG/NFG. Fourteen patients with DNR orders placed preoperative were excluded from analyses. For the remaining 636 patients, the overall 30-day mortality was 10.1% (64/636). Fifty-seven percent (360/636) of patients were male, 70% (446/636) were white and 13% (81/636) were African-American. Table 1 details age, BMI, and preoperative laboratory values and Table 2 lists categorical preoperative factors associated with increased risk for 30-day mortality. Multivariate logistic regression indicated that increased age (OR 1.041, p=0.004), BMI (OR 1.045, p< 0.001), and preoperative WBC (OR 1.061, p=0.001), and decreased platelet count (OR 0.993, p< 0.001) were all associated with increased risk of death. Table 1. Age, BMI, and preoperative laboratory values Did not die within 30 days of surgery - mean (SD) Died with 30 days of surgery - mean (SD) p-value, univariate Age - years 53.2(14.9) 63.4(15.4) <0.001 BMI - kg/m2 34.8(12.2) 39.6(18.1) 0.065 WBC 15.8(7.6) 19.1(9.6) 0.011 Hematocrit 33.8(6.8) 32.0(6.4) 0.049 Platelet count 292.1(133.4) 210.3(92.3) <0.001 Sodium 135.5(4.9) 136.0(6.4) 0.547 Creatinine 1.5(1.4) 2.1(1.3) 0.004 Albumin 2.6(0.9) 2.1(0.6) <0.001 Total bilirubin 1.0(1.3) 1.5(1.7) 0.007 SGOT 43.1(61.4) 47.6(36.4) 0.455 Alkaline phosphatase 123.1(91.7) 141.0(101.6) 0.194 INR 1.4(0.6) 1.4(0.3) 0.232 Table 2. Categorical preoperative factors Associated with increased risk of 30-day mortality (p-value) Not associated with increased risk of 30-day mortality (p-value) Increased ASA class (< 0.001) Sex (0.184) On ventilator within 48hrs of surgery (< 0.001) Race (0.697) On dialysis within 2w of surgery (0.003) Diabetes (0.854) Not smoking within 1yr of surgery (< 0.001) ≥ 2 ETOH drinks per day (0.499) History of congestive heart failure (0.045) Chronic steroid use (0.227) History of myocardial infarction (0.097) History of COPD (0.235) CPT code (0.055) Operative year (0.799) CONCLUSIONS Using a nationwide, contemporary sample, we identified the 30-day surgical mortality rate for FG/NFG as 10.1%. This rate is about half of previously published estimates, which may indicate improvements in therapy. Increased age, BMI, and WBC, and decreased platelet count were all associated with an increased risk of 30-day mortality. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e443 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information James M. Dupree Chicago, IL More articles by this author Brian V. Le Chicago, IL More articles by this author Dae Y. Kim Chicago, IL More articles by this author Lee C. Zhao Chicago, IL More articles by this author John P. Cashy Chicago, IL More articles by this author Shilajit D. Kundu Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...