Artikel
The first doctor’ advice as a remarkable factor in the mortality of Fournier’s gangrene
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Autoren
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Constantin Rieger
- Urologie Uniklinik Köln, Köln, Germany
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Max Hübers
- Urologie Uniklinik Köln, Köln, Germany
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Lucas Kastner
- Urologie Uniklinik Köln, Köln, Germany
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David Pfister
- Urologie Uniklinik Köln, Köln, Germany
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Axel Heidenreich
- Urologie Uniklinik Köln, Köln, Germany
| Veröffentlicht: | 28. März 2023 |
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Gliederung
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Introduction: Fournier’s gangrene is a life-threatening urological disease, which requires rapid surgical intervention. Despite major improvements in medical therapy, the mortality of Fournier’s gangrene has not changed during the last 25 years. To potentially improve the outcome, we analyzed different medical processes in terms of overall mortality in the treatment of the Fournier’s gangrene.
Methods: We performed a retrospective single-center study of 21 patients with Fournier’s gangrene. Patients were grouped according to initial symptoms, first medical advice, blood tests, medical history and further clinical processes and compared with student’s t-test, Fisher’s exact test or chi-squared test. Log-rank test was used for overall survival. The follow up was carried out until 120 days after the first surgical intervention.
Results: There were no significant differences in the mortality rate of patients depending on the day and time of presentation in the hospital. Of the patients first consulting an urologist (either outpatient or hospital) no patient died within the first 120 days. In contrast, almost 70% of the patients who were transferred by a hospital without urologic specialization, or a non-urologic outpatient clinic (p=0.005) died within the first 120 days after surgery. Multivariate analysis has proven the first doctor’s advice as a significant factor in determining the patient’s mortality (p=0.003), which also correlated with a significantly shorter duration of the first surgical procedure (110 minutes vs. 54 minutes, p=0.019). Further risk factors for mortality were age and diabetes.
Conclusion: Despite the small cohort, we were able to show the significant correlation between the initial doctor’s advice, either by urologist or non-urologist, and the patient’s mortality. Considering the life-threatening potential of Fournier’s gangrene, professionals should develop strategies to educate non-urologists and raise awareness about this disease and its clinical presentation in order to optimize rapid intervention and reduce the mortality.
