Effectiveness of a Regionalized Care Model in Treating Fournier’s Gangrene

Abstract

Objectives

To evaluate the impact of transferring patients with Fournier's gangrene (FG) to a tertiary referral hospital (TRH) on survival and outcomes.

Methods

We conducted a retrospective analysis of FG cases treated at our TRH from January 2015 to January 2022. Clinicodemographic, laboratory, perioperative, and mortality data were collected. Patients were categorized into two groups: those directly presented (DP) to TRH and those transferred for treatment (TT) from other hospitals. Primary outcome was 30-day mortality. Secondary outcomes included 90-day, 180-day, 1-year and 2-year mortality. We employed chi-square, T-tests, and Fisher's exact tests for significance assessment. Survival was evaluated using Kaplan-Meier.

Results

136 patients (77.9% males) were analyzed: 66.9% in the TT group (n = 91), 33.1% in DP group (n = 45), with median ages of 59.2 and 56.4, respectively, P = 0.06. Median transfer distance: 10.6 miles, travel time: 16 minutes. No significant differences were observed in time from presentation to initial debridement (8.45 hours for TT, 7.3 hours for DP, P = 0.57), comorbidities, or FG Severity Index. No significant differences in 30-day mortality (TT: 5.5%, DP: 4.4%, [HR = 1.53, 95% CI: 0.31, 7.57], P = 0.6), or other mortality rates (90-day: 7.7% vs 6.6%, 180-day: 14.3% vs 8.9%, 1-year: 18.7% vs 15.6%, 2-year: 20.9% vs 15.6%, P > 0.05). DP had a higher rate of fast door-to-operation room (<6 hours) than TT (46.7% vs 18.7%, P = 0.06), although 30-day mortality was not affected.

Conclusions

Transfer of FG patients to a TRH was not associated with increased mortality. Due to the rarity and complexity of this disease, centralizing care might be the preferred approach in cases of regional primary presentation.