Outcome Analysis in Patients With Fournier’s Gangrene Report of 45 Cases Mustafa Korkut, M.D.,* Go ¨khan I ˙ c ¸o ¨z, M.D.,* Murat Dayangac ¸, M.D.,* Erhan Akgu ¨n, M.D.,* Levent Yeniay, M.D.,* O ¨ zgu ¨r Erdog ˘an, M.D.,† C ¸ ag ˘C ¸ al, M.D.† From the Departments of *General Surgery and †Urology, Ege University Medical Faculty, Izmir, Turkey INTRODUCTION: Despite antibiotics and aggressive de- bridement, the mortality rate of Fournier’s gangrene re- mains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking. METHODS: The medical records of 45 patients with Fournier’s gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mor- tality. Univariate analysis was performed using the chi- squared test and Fisher’s exact probability test, then multi- variate analysis of statistically significant variables was performed using logistic regression. RESULTS: The most prominent associated disease was diabetes, affecting 55.6 percent of the patients. The overall mortality rate was 20 percent. However, the mortality rate among diabetics was 36 percent (P = 0.002). The other statistically significant predictors of outcome were the interval from the onset of symptoms to the initial surgical intervention (P = 0.001) and the need of fecal diversion (P = 0.009). Multivariate regression analysis disclosed that the interval from the onset of symptoms to the initial surgical intervention and diabetes were independent predictors of mortality (P = 0.001 and P = 0.003, respectively). CONCLUSION: The interval from the onset of clinical symptoms to the initial surgical inter- vention seems to be the most important prognostic factor with a significant impact on outcome. Given the signifi- cantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic ef- forts, Fournier’s gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management. [Key words: Fournier’s gan- grene; Necrotizing fasciitis; Outcome analysis] Korkut M, I ˙ c ¸o ¨z G, Dayangac ¸ M, Akgu ¨n E, Yeniay L, Erdog ˘an O ¨ ,C ¸al C ¸. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum 2003;46: 649–652. J ean Alfred Fournier, after whom the term “Fourni- er’s gangrene” (FG) was named, was the first to describe the fulminant gangrene of the penis and scrotum in 1883. 1 Fournier’s original description in- cluded five otherwise healthy young males with scro- tal gangrene and emphasized the sudden onset of the disease in the absence of a definite cause with a rapid progression to gangrene. 2 Since that time, hundreds of cases have been reported in the literature. In the light of many additional descriptions, the disease is now defined as synergistic, polymicrobial, necrotizing fasciitis of the perineum, scrotum, and penis, which is characterized by obliterative endarteritis of the sub- cutaneous arteries resulting in gangrene of the sub- cutaneous tissue and the overlying skin. 3 In recent studies the disease is far from being idio- pathic, and a cause can be found in about 95 percent of the cases, with a preponderance of anorectal sourc- es. 4,5 Despite the decreased number of idiopathic cases and better understanding of the pathophysiol- ogy of the disease, mortality rates remain high, and improved antimicrobial therapy and medical care do not seem to give a reliable survival benefit. 6 Although conservative treatment without surgery may suffice in some cases, FG remains a surgical emergency and early recognition and prompt radical debridement are the mainstays of management. 2 Treatment of FG needs to be individualized, and it requires reliable prognostic indicators. Despite at- tempts to define factors that may influence prognosis and survival, controversy remains mostly because many studies have been small and statistical analysis was not performed. In this study, we investigated the prognostic variables of mortality in patients with FG using multivariate statistical analysis of a series of 45 patients treated in a single center during a 12-year period. MATERIALS AND METHODS The medical records of 45 consecutive patients with necrotizing fasciitis of the perianal, genital, or peri- neal regions, who presented at the Ege University Presented at the joint meeting of Mediterranean Society of Colo- proctology and Turkish Association of Colorectal Surgeons, Anta- lya, Turkey, September 9 to 13, 2001. Address reprint requests to Dr. Dayangac ¸: Ege Universitesi Tip Fakultesi, Genel Cerrahi Anabilim Dali, Bornova (35100), Izmir, Turkey. 649