Mitaka Hayato, McQuerry Kristen, Karnik Kelsey, Marra Alexandre R, Naito Toshio, Ten Eyck Patrick, Auwaerter Paul G, Yamada Yuji, Kobayashi Takaaki
Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Aug 7;5(1):e178. doi: 10.1017/ash.2025.10084. eCollection 2025.
Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) of the perineum. Recent retrospective studies from quaternary centers suggest improved outcomes and a potentially less aggressive clinical course for FG than non-perineal NSTIs. However, comprehensive nationwide data remain limited.
This retrospective cohort study analyzed the National Inpatient Sample (2016-2020) to compare outcomes between FG and non-perineal NSTIs. Adult patients undergoing surgical debridement with a diagnosis of FG or NSTI were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), hospital costs, and home discharge rates. Multivariable regression analyses adjusted for patient demographics, comorbidities, and hospital characteristics.
A total of 5,007 FG and 24,782 non-perineal NSTI patients were identified. Crude in-hospital mortality rates were 5.8% for FG and 5.4% for non-perineal NSTIs, with stable trends observed over five years. After adjustment, no significant difference in mortality was observed (adjusted odds ratio [aOR]: 1.04; 95% CI: 0.90-1.20). However, FG was associated with longer LOS (adjusted mean difference: 1.99 days; 95% CI: 1.53-2.46) and higher hospital costs ($37,809 higher; 95% CI: $29,540-$46,077). Home discharge rates were similar between groups (aOR: 0.97; 95% CI: 0.89-1.05).
Despite similar mortality rates, FG hospitalizations were associated with increased LOS and higher costs compared to non-perineal NSTIs. These findings may suggest potential nationwide disparities in FG care quality, particularly outside specialized referral centers. Further research is needed to understand if standardized care pathways tailored to FG may optimize management and reduce resource utilization.
福尼尔坏疽（FG）是一种会阴部坏死性软组织感染（NSTI）。来自四级医疗中心的近期回顾性研究表明，与非会阴部NSTIs相比，FG的治疗效果有所改善，临床病程可能也不那么凶险。然而，全国范围内的综合数据仍然有限。
这项回顾性队列研究分析了国家住院样本（2016 - 2020年），以比较FG和非会阴部NSTIs的治疗效果。使用ICD - 10编码确定接受手术清创且诊断为FG或NSTI的成年患者。研究结果包括住院死亡率、住院时间（LOS）、住院费用和出院回家率。多变量回归分析对患者人口统计学、合并症和医院特征进行了调整。
共确定了5007例FG患者和24782例非会阴部NSTI患者。FG的粗住院死亡率为5.8%，非会阴部NSTIs为5.4%，五年间呈稳定趋势。调整后，未观察到死亡率有显著差异（调整后的优势比[aOR]：1.04；95%置信区间：0.90 - 1.20）。然而，FG与更长的住院时间相关（调整后的平均差异：1.99天；95%置信区间：1.53 - 2.46）以及更高的住院费用（高出37809美元；95%置信区间：29540美元 - 46077美元）。两组间出院回家率相似（aOR：0.97；95%置信区间：0.89 - 1.05）。
尽管死亡率相似，但与非会阴部NSTIs相比，FG住院患者的住院时间更长，费用更高。这些发现可能表明FG护理质量在全国范围内存在潜在差异，尤其是在专科转诊中心之外。需要进一步研究以了解针对FG量身定制的标准化护理路径是否可以优化管理并减少资源利用。
