Fournier

Tech Coloproctol (2010) 14:217–223 DOI 10.1007/s10151-010-0592-1

ORIGINAL ARTICLE

Fournier’s gangrene: an analysis of 80 patients and a novel scoring system
T. Yilmazlar • E. Ozturk • H. Ozguc I. Ercan • H. Vuruskan • B. Oktay
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Received: 5 April 2010 / Accepted: 1 June 2010 / Published online: 18 June 2010 Ó Springer-Verlag 2010

Abstract Background To create a better scoring systemfor outcome prediction for patients with Fournier’s gangrene in order to design more appropriate and feasible management strategies. Methods Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier’s gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with theFournier’s gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score. Results The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P \ 0.001). Thereceiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002). Conclusions The power of the novel scoring system introduced in this study proves that in patients with

Fournier’s gangrene, the extent of the gangrene as well as the patient’s age and physiological status have a significant effect on the outcome. KeywordsFournier’s gangrene Á Mortality Á Dissemination Á Severity index

Introduction Fournier’s gangrene is a potentially fatal disease characterized by necrotizing fasciitis of the perineal and genital region resulting from synergistic polymicrobic infection [1–5]. It is a surgical emergency and requires prompt surgical intervention [6–10]. Mortality rates in Fournier’s gangrene range from 0 to 67% [1–25],which indicates that the outcome of patients with the disease is multifactorial. Factors that affect the outcome of patients with Fournier’s gangrene can be classified into 3 groups; diseaserelated factors, host-related factors, and physician-related factors. Prompt and aggressive surgical debridements with appropriate antibiotics are physician-related factors. The physiological status of the patient,which can be monitored by the Acute Physiology and Chronic Health Evaluation (APACHE) II [8, 17] or Fournier’s Gangrene Severity Index (FGSI) score [1, 10–13] and age are host-related factors. Dissemination of the disease describes the aggressiveness of the infectious agents that cause Fournier’s gangrene or reflects immunodepression of the host. Nevertheless, dissemination of the disease wasproven to affect outcomes in previous reports [6, 7, 10, 15]. The FGSI can predict mortality with a probability of 75% and survival with a probability of 78% for patients with Fournier’s gangrene [8]. Many authors have found it useful [1, 10–13]; however, we believe that it underscores

T. Yilmazlar Á E. Ozturk (&) Á H. Ozguc Department of General Surgery, Uludag University School of Medicine,Gorukle, 16069 Bursa, Turkey e-mail: drozturk@uludag.edu.tr I. Ercan Department of Biostatistics, Uludag University School of Medicine, Bursa, Turkey H. Vuruskan Á B. Oktay Department of Urology, Uludag University School of Medicine, Bursa, Turkey

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the prognosis and may be improved. Therefore, we investigated the effect of the above-mentioned 3groups of factors on outcome and constructed a novel scoring system by modifying the FGSI. The scoring system takes the acute physiological status of the patient and patient’s age and combines these with the extent of the disease, and can easily be applied in routine clinical practice.

Materials and methods The prospectively maintained medical records of patients presenting with Fournier’s...