Surviving Fournier's gangrene: Multivariable analysis and a novel scoring system to predict length of stay

Saum B Ghodoussipour; Daniel Gould; Jacob Lifton; Ido Badash; Aaron Krug; Gus Miranda; Jeffrey Loh-Doyle; Joseph Carey; Hooman Djaladat; Leo Doumanian; David Ginsberg

doi:10.1016/j.bjps.2017.12.005

Surviving Fournier's gangrene: Multivariable analysis and a novel scoring system to predict length of stay

J Plast Reconstr Aesthet Surg. 2018 May;71(5):712-718. doi: 10.1016/j.bjps.2017.12.005. Epub 2017 Dec 14.

Authors

Affiliations

¹ Department of Urology, University of Southern California, 1441 Eastlake avenue, Los Angeles, CA, USA 90030.
² Division of Plastic and Reconstructive Surgery, University of Southern California, 1510 san pablo street, Los Angeles, CA, USA 90030. Electronic address: daniel.gould@med.usc.edu.
³ Keck Medical School, University of Southern California, 1975 zonal avenue, Los Angeles, CA, USA 90030.
⁴ Division of Plastic and Reconstructive Surgery, University of Southern California, 1510 san pablo street, Los Angeles, CA, USA 90030.

PMID: 29284566
DOI: 10.1016/j.bjps.2017.12.005

Abstract

Background: 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.

Methods: 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.

Results: 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).

Discussion: 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.

Keywords: Fournier's gangrene; Genital reconstruction; Necrotizing soft tissue infections; Urological reconstruction.

MeSH terms

Female
Fournier Gangrene / mortality*
Fournier Gangrene / surgery*
Humans
Length of Stay / statistics & numerical data*
Male
Middle Aged
Plastic Surgery Procedures
Predictive Value of Tests
Retrospective Studies
Severity of Illness Index