Department of Urology, University of Southern California, 1441 Eastlake avenue, Los Angeles, CA, USA 90030.
Division of Plastic and Reconstructive Surgery, University of Southern California, 1510 san pablo street, Los Angeles, CA, USA 90030.
J Plast Reconstr Aesthet Surg. 2018 May;71(5):712-718. doi: 10.1016/j.bjps.2017.12.005. Epub 2017 Dec 14.
There is no contemporary scoring system to predict hospital length of stay and morbidity in Fournier's gangrene. A retrospective study was conducted to formulate a scoring system to predict duration of hospitalization, resource utilization, need for reconstruction, morbidity and mortality.
A retrospective chart review was performed on 54 patients treated for FG from 2010-2016 at LAC+USC Medical Center, the largest public hospital in Los Angeles County. Strobe guidelines were followed and the study was approved by the IRB. Predictors of LOS, morbidity, mortality and resource utilization were identified and univariate linear regressions performed to determine significance. Significant univariate predictors were used to develop a novel scoring system, the Combined Urology and Plastics Index (CUPI). The CUPI score was then compared to existing scoring systems for predicting length of stay.
The mean patient age was 49.3, and the mean BMI was 28.6. Patients on average were hospitalized for 37.5 days, with a mean of 8.3 days in the ICU. Three patients (5.6%) died during their hospital stay, and 33 (61%) required reconstructive surgery. Multivariate logistic modeling showed that BMI (p = 0.001) and alkaline phosphatase (p < 0.001) correlated with decreasing length of stay, while age at admission was not significantly correlated (p = 0.369). Univariate analysis of existing scoring systems showed that FGSI, LRINEC, NLR, and CCI were not significantly correlated with length of stay, while the newly calculated CUPI score was shown to be a significant predictor of longer hospital stays (p = 0.001).
Early emphasis on supportive care, nutrition, and involvement of reconstructive surgeons can decrease LOS in patients with Fournier's gangrene. The CUPI score on admission may be a useful tool for predicting LOS in this population.
目前尚无预测 Fournier 坏疽患者住院时间和发病率的当代评分系统。本回顾性研究旨在制定一种评分系统，以预测住院时间、资源利用、重建需求、发病率和死亡率。
对 2010 年至 2016 年在洛杉矶县最大的公立医院 LAC+USC 医疗中心接受 FG 治疗的 54 例患者进行回顾性图表审查。遵循 STROBE 指南，并经 IRB 批准进行了该研究。确定了 LOS、发病率、死亡率和资源利用的预测因素，并进行了单变量线性回归以确定其显著性。使用单变量显著预测因子来开发一种新的评分系统，即联合泌尿科和整形外科指数（CUPI）。然后，将 CUPI 评分与现有的预测住院时间的评分系统进行比较。
患者的平均年龄为 49.3 岁，平均 BMI 为 28.6。患者平均住院 37.5 天，ICU 平均住院 8.3 天。有 3 名患者（5.6%）在住院期间死亡，33 名患者（61%）需要重建手术。多变量逻辑建模显示 BMI（p=0.001）和碱性磷酸酶（p<0.001）与住院时间缩短相关，而入院时的年龄与住院时间无显著相关性（p=0.369）。对现有评分系统的单变量分析表明，FGSI、LRINEC、NLR 和 CCI 与住院时间无显著相关性，而新计算的 CUPI 评分是住院时间延长的显著预测因子（p=0.001）。
早期强调支持性护理、营养和重建外科医生的参与可以缩短 Fournier 坏疽患者的住院时间。入院时的 CUPI 评分可能是预测该人群住院时间的有用工具。
