Artikel
Why underrepresentation costs lives: Results from a high-volume multi-institutional study about risk factors for mortality in Fournier’s gangrene
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Autoren
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Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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M. Hübers
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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Enno Storz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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S. Schleifer
- Department of Urology, University of Augsburg, Augsburg, Germany
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Jennifer Kranz
- Department of Urology, University Hospital RWTH Aachen, Aachen, Germany
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B. Gerdes
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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V. Pantea
- Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
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L. Püllen
- Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
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A. Chachin
- Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
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M. Träger
- Department of Urology, University of Freiburg, Freiburg, Germany
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P. Henniges
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
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M. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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J. Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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F. Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
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M. Dellino
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
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U. Jany
- Department of Urology, Medical School, University of Leipzig, Leipzig, Germany
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M. Tylingr
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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K. Al Assali
- University Hospital Magdeburg, Magdeburg, Germany
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P. Patroi
- Department of Urology and Urosurgery, University Medical Center Mannheim, Mannheim, Germany
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R. Mayr
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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S. Engelmann
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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L. Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
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F. Zengerling
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
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Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| Veröffentlicht: | 26. März 2024 |
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Gliederung
Text
Introduction: Fournier’s gangrene is the most life-threatening urological disease, which requires rapid surgical intervention. Despite major improvements in treatment of urological diseases, particularly in uro-oncology, the mortality of Fournier’s gangrene has not changed during the last 25 years. We recently have shown in a small cohort that the first medical advice is a remarkable factor for mortality. In our German multi-center study, we wanted to proof this parameter and figure out further risk factors.
Methods: We performed a retrospective multi-center study of 225 patients from 16 tertiary care hospitals in Germany with Fournier’s gangrene between 2010 and 2023. 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 50 days after the first surgical intervention.
Results: There were no significant differences in the mortality of patients depending on the day and time of presentation in the hospital. We also found no risk factors for mortality regarding the patient’s history (e.g. diabetes, age) or laboratory values (e.g. CRP, leucocytes, albumin). Of the patients first consulting an urologist (either outpatient or hospital) about 3% died within the first 50 days. In contrast, almost 35% of the patients who were transferred by a hospital without urologic specialization, or a non-urologic outpatient clinic (Hazard ratio (HR) 6.5; 95% CI 3.1 to 13.31; p<0.0001) died within the first 50 days after surgery. First presenting to an urologist also significantly reduced the chance to admission to Intensive Care Unit (Odds Ratio (OR) 0.28; 95% CI; 0.15 to 0.51; p<0.0001).
Conclusion: We were able to prove in a very large cohort of this rare disease, that the initial medical consultation is the determining factor for mortality in Fournier’s gangrene. 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.
