Predictors of Postoperative Mortality in Patients with Fournier's Gangrene

Purpose. To identify the clinical risk factors associated with postoperative mortality in patients with Fournier's gangrene. Methods. We retrospectively enrolled 36 patients who were treated for Fournier's gangrene during the period January 2006 to December 2012 at the Changhua Christian Hospital. Univariate and multivariate analyses were used to investigate possible risk factors for post-operative mortality in patients with Fournier's gangrene, including renal dysfunction, intensive care unit admission, age, respiratory rate, potassium, creatinine, medical history (diabetes mellitus, DM; hypertension, renal failure, and liver cirrhosis), origin of infection, history of malignancy, the presence of stoma, the number of operations, vital signs, the level of electrolytes, hematocrit, and Fournier's gangrene severity index. Results. Mean age was 59.97 ± 15.3 years (range, 24-91 years) and most of the patients were men (32 of 36, 89%). The overall mortality rate was 30.5% (11 of 32). The most common predisposing illnesses were diabetes mellitus (52.8%) and hypertension (50%). The average Fournier's gangrene severity index (FGSI) score on admission was 6.5. All patients required radical surgical debridement and the majority (n = 25, 69%) required more than one session (mean, 2.8; range 2-4). Diverting colostomy was performed in 44.4% of patients. Although the univariate analysis showed that age, sex, renal dysfunction, intensive care unit admission, and most of the individual variables that make up the FGSI score were significant predictors of postoperative death, the mulitivariate analysis revealed that only the index score itself was an in independent predictor of postoperative mortality. Conclusion. The Fournier's gangrene severity index score at admission is predictive of postoperative outcome.