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Hyperbaric oxygen for the treatment of fournier's gangrene.
J Urol. 2005 Jun; 173(6):1975-7.JU

Abstract

PURPOSE

Fournier's gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease. We also analyzed predictors of extended hospital stay and mortality.

MATERIALS AND METHODS

The records of patients with the hospital discharge diagnoses of Fournier's gangrene, necrotizing fasciitis, gangrene of the genitalia and scrotal gangrene from 1993 to 2002 were reviewed. Data concerning clinical presentation characteristics, hospital stay, complications, hospital charges and outcomes, including graft failure and death, were analyzed.

RESULTS

A total of 42 patients were identified and followed a median 4.2 years. Of the patients 16 underwent surgical debridement and antibiotic therapy alone, and 26 were treated with HBO plus surgery and antibiotics. Overall disease specific mortality was 21.4%, that is 12.5% in the nonHBO group and 26.9% in the HBO group. Three or more complications occurred in 13% of nonHBO and in 19% of HBO cases, of which the most common was myocardial infarction. The skin graft failure rate was 6% (nonHBO) and 8% (HBO). Physical disability was a statistically significant predictor of extended hospital stay (p <0.01). There was a trend toward a correlation between known coronary artery disease and death (p = 0.2). A statistically significant difference was noted in average daily hospital charges in nonHBO vs HBO cases ($2,552 vs $3,384 daily, p <0.01).

CONCLUSIONS

These data do not support routine HBO in the treatment of Fournier's gangrene. There was a trend toward higher morbidity and mortality in the HBO group, suggesting that treatment may have been given to patients who were more ill.

Authors+Show Affiliations

Departments of Urology and Surgery, University of Iowa, Iowa City, Iowa, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15879795

Citation

Mindrup, Steven R., et al. "Hyperbaric Oxygen for the Treatment of Fournier's Gangrene." The Journal of Urology, vol. 173, no. 6, 2005, pp. 1975-7.
Mindrup SR, Kealey GP, Fallon B. Hyperbaric oxygen for the treatment of fournier's gangrene. J Urol. 2005;173(6):1975-7.
Mindrup, S. R., Kealey, G. P., & Fallon, B. (2005). Hyperbaric oxygen for the treatment of fournier's gangrene. The Journal of Urology, 173(6), 1975-7.
Mindrup SR, Kealey GP, Fallon B. Hyperbaric Oxygen for the Treatment of Fournier's Gangrene. J Urol. 2005;173(6):1975-7. PubMed PMID: 15879795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperbaric oxygen for the treatment of fournier's gangrene. AU - Mindrup,Steven R, AU - Kealey,G Patrick, AU - Fallon,Bernard, PY - 2005/5/10/pubmed PY - 2005/6/4/medline PY - 2005/5/10/entrez SP - 1975 EP - 7 JF - The Journal of urology JO - J Urol VL - 173 IS - 6 N2 - PURPOSE: Fournier's gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease. We also analyzed predictors of extended hospital stay and mortality. MATERIALS AND METHODS: The records of patients with the hospital discharge diagnoses of Fournier's gangrene, necrotizing fasciitis, gangrene of the genitalia and scrotal gangrene from 1993 to 2002 were reviewed. Data concerning clinical presentation characteristics, hospital stay, complications, hospital charges and outcomes, including graft failure and death, were analyzed. RESULTS: A total of 42 patients were identified and followed a median 4.2 years. Of the patients 16 underwent surgical debridement and antibiotic therapy alone, and 26 were treated with HBO plus surgery and antibiotics. Overall disease specific mortality was 21.4%, that is 12.5% in the nonHBO group and 26.9% in the HBO group. Three or more complications occurred in 13% of nonHBO and in 19% of HBO cases, of which the most common was myocardial infarction. The skin graft failure rate was 6% (nonHBO) and 8% (HBO). Physical disability was a statistically significant predictor of extended hospital stay (p <0.01). There was a trend toward a correlation between known coronary artery disease and death (p = 0.2). A statistically significant difference was noted in average daily hospital charges in nonHBO vs HBO cases ($2,552 vs $3,384 daily, p <0.01). CONCLUSIONS: These data do not support routine HBO in the treatment of Fournier's gangrene. There was a trend toward higher morbidity and mortality in the HBO group, suggesting that treatment may have been given to patients who were more ill. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/15879795/Hyperbaric_oxygen_for_the_treatment_of_fournier's_gangrene_ L2 - https://www.jurology.com/doi/10.1097/01.ju.0000158129.56571.05?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -