Higher Morbidity and Mortality in Females With Fournier's Gangrene Compared to Males: Insights From National Inpatient Sample Data.

Abstract

Purpose: To compare Fournier's gangrene in female and male patients, and identify mortality-associated characteristics in both.

Materials and methods: We employed National Inpatient Sample data (2016-2020) to identify Fournier's gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were utilized to identify mortality risk factors for both cohorts.

Results: We identified 2875 females (31%) and 6451 males (69%) with Fournier's gangrene corresponding to an estimated 14,375 (95% CI 13,784-14,966) and 32,255 (95% CI 31,390-33,120) cases, respectively. Females were more likely to die than males (7.1% vs 5.7%, P < .0001, respectively). Median incidence rates were 1.7 (IQR 1.5-1.8) and 4 (IQR 3.6-4.3) cases per 100,000 person-years for females and males, respectively. Females had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than males (P < .05). Non-White females had increased mortality odds compared to White females (odds ratio [OR] 1.49, 95% CI 1.07-2.07, P = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both females and males (OR 1.02, 95% CI 1-1.04, P = .034 vs OR 1.03, 95% CI 1.01-1.05, P < .0001). Diabetes lowered mortality odds in females and males (OR 0.68, 95% CI 0.47-0.99, P = .046 vs OR 0.54, 95% CI 0.41-0.7, P < .0001).

Conclusions: In females, Fournier's gangrene incidence surpasses previous reports, with slightly worse outcomes compared to males, emphasizing the need for precise clinical assessment and early intensive interventions.