Fournier’s gangrene: analysis of risk factors affecting the prognosis and cost of therapy in 18 cases

BACKGROUND
Fournier’s gangrene (FG) is a rapidly progressive, polymicrobial, synergistic necrotizing fasciitis, and the mortality rate is still high. We aimed to determine the risk factors affecting prognosis and treatment cost.
METHODS
Eighteen patients operated for FG during 2003-2007 were investigated retrospectively. Surviving and exitus groups were compared regarding demographic data, etiological factors, laboratory findings, treatment modality, length of hospital stay, and treatment cost.
RESULTS
Mean age was 54.5 years, and the female/male ratio was 6/12. Mortality was observed in 6 (33.3%) patients and was significantly high among females (66.6%) (p=0.035). Mean duration of complaint in the exitus group (9±3 days) was higher than in survivors (5±3 days) (p=0.018). The most frequent comorbid disease was diabetes (39.2%), the most frequent etiology was perianal abscess (55.6%) and the primary location of infection was anorectal region (61.1%). Hyponatremia was significantly high in surviving patients (p=0.039). Mean of FG severity point in the exitus group (6.83) was higher than in survivors (3.17) (p=0.011). The most frequently cultivated microorganism, Escherichia coli (66.6%), was significantly high in the exitus group (p=0.012). The mean number of debridements was 4.67. Fecal diversion was performed in 7 (38.8%) patients. Hospital stay in the surviving group (34.17 days) was higher than in the exitus group (10.50 days) (p=0.002). Treatment cost between groups was indifferent (p>0.05).
CONCLUSION
Female gender, duration of complaint, FG severity point, and cultivated microorganism (E. coli) were thought to affect mortality. FG is a disease that might cause extended hospital stay and high treatment cost.

Fournier gangreni: 18 olgudaki prognoza etki eden risk faktörlerinin ve tedavi maliyetinin deðerlendirilmesi

AMAÇ
Fournier gangreni (FG) hýzlý ilerleyen sinerjistik, polimikrobiyal nekrotizan fasiittir. Hastalýðýn mortalitesi halen yüksektir. Çalýþmamýzda hastalarýn prognozuna etki eden risk faktörlerini ve tedavi maliyetini belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM
2003-2007 yýllarý arasýnda FG nedeniyle ameliyat edilen 18 hastanýn dosyalarý retrospektif olarak incelendi. Yaþayan ve ölümcül seyreden hasta gruplarý demografik özellikler, etyolojik faktörler, laboratuvar bulgularý ve tedavi uygulamalarý yaný sýra hastanede kalýþ süresi ve tedavi giderleri yönünden karþýlaþtýrýldý.

BULGULAR
Hastalarýn yaþ ortalamasý 54,5 ve kadýn/erkek oraný 6/12 idi. Mortalite 6 (%33,3) hastada gözlendi ve kadýnlarda (%66,6) anlamlý þekilde fazlaydý (p=0,035). Þikâyet süresi ölümcül seyreden hastalarda (9±3 gün) yaþayanlardan (5±3 gün) fazlaydý (p=0,018). En sýk; yandaþ hastalýk diyabet (%39,2), etyoloji perianal apse (%55,6), enfeksiyonun primer yerleþimi anorektal bölgeydi (%61,1). Hiponatremi yaþayan hastalarda fazlaydý (p=0,039). FG þiddet puaný ortalamasý ölümcül seyredenlerde (6,83) yaþayanlardan (3.17) fazlaydý (p=0,011). Hastalarda en sýk üreyen bakteri E.coli’ydi (%66,6) ve mortal seyreden hastalarda anlamlý þekilde fazlaydý (p=0,012). Hastalarýn debridman sayýsý ortalamasý 4,67 idi. Fekal diversiyon 7 (%38,8) hastaya uygulanmýþtý. Hastanede yatýþ süresi yaþayanlarda (34,17 gün) ölümcül (10,50 gün) olanlardan fazlaydý (p=0,002). Hasta gruplarýnýn tedavi maliyeti farksýzdý (p>0,05).
SONUÇ
Kadýn cinsiyeti, tedavi öncesi geçen þikâyetin süresi, FG þiddet puaný ve kültürde üreyen mikroorganizmanýn (E. coli) mortaliteyi etkileyebileceði düþünülmektedir. FG tedavi süresi uzun ve maliyeti fazla olabilecek bir hastalýktýr.