Sorensen Mathew D, Krieger John N
Department of Urology, University of Washington School of Medicine, Seattle, Wash., USA.
Urol Int. 2016;97(3):249-259. doi: 10.1159/000445695. Epub 2016 May 14.
Case series reported 20-40% mortality rates for patients with Fournier's gangrene with some series as high as 88%. This literature comes almost exclusively from referral centers.
We identified and analyzed inpatients with Fournier's gangrene who had a surgical debridement or died in the US State Inpatient Databases.
One thousand six hundred and forty one males and 39 females with Fournier's gangrene represented <0.02% of hospital admissions. Overall, the incidence was 1.6 cases per 100,000 males and case fatality was 7.5%. Sixty six percent of hospitals cared for no cases per year, 17% cared for 1 case per year, 10% cared for 2 cases per year, 4% cared for 3 cases per year, 1% cared for 4 cases per year, and only 1% cared for ≥5 cases per year. Teaching hospitals had higher mortality (adjusted OR 1.9) due primarily to more acutely ill patients. Hospitals treating more than 1 Fournier's gangrene case per year had an adjusted 42-84% lower mortality (p < 0.0001).
Most hospitals rarely care for Fournier's gangrene patients. The population-based mortality rate (7.5%) was substantially lower than the case series from tertiary care centers. Hospitals that treated more number of Fournier's gangrene patients had lower mortality rates, thereby supporting the rationale that regionalized care worked well for patients with this rare disease.
病例系列报道显示，福尼尔坏疽患者的死亡率为20% - 40%，有些系列报道的死亡率高达88%。这些文献几乎都来自转诊中心。
我们在美国国家住院患者数据库中识别并分析了接受手术清创或死亡的福尼尔坏疽住院患者。
1641名男性和39名女性患有福尼尔坏疽，占住院人数的比例不到0.02%。总体而言，发病率为每10万名男性中有1.6例，病死率为7.5%。66%的医院每年没有收治此类病例，17%的医院每年收治1例，10%的医院每年收治2例，4%的医院每年收治3例，1%的医院每年收治4例，只有1%的医院每年收治≥5例。教学医院的死亡率较高（校正后的比值比为1.9），主要原因是患者病情更危急。每年治疗超过1例福尼尔坏疽病例的医院，其校正后的死亡率降低了42% - 84%（p < 0.0001）。
大多数医院很少收治福尼尔坏疽患者。基于人群的死亡率（7.5%）显著低于三级医疗中心的病例系列报道。治疗福尼尔坏疽患者数量较多的医院死亡率较低，从而支持了这样一种理论，即区域化治疗对这种罕见疾病的患者效果良好。
Zotero 插件