Gender differences in clinical features and outcomes of Fournier's gangrene among emergency department patients.

Abstract

Background: Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineal, genital, and perianal regions that predominantly affects men and carries substantial morbidity and mortality. The presentation and outcomes of FG in women remain less well characterized. Our objective was to compare clinical characteristics, treatment, and short-term outcomes between male and female emergency department patients with FG.

Methods: This retrospective cohort study included adult patients presenting to the EDs of 11 affiliated hospitals across 19 counties in Michigan from 2012 to 2024 with a final diagnosis of FG. Demographics, clinical characteristics, treatments, and outcomes were abstracted and compared between sexes. Primary outcomes included in-hospital death, 30-day mortality, length of stay, readmission, and surgical burden.

Results: Among 166 patients, 134 (80.7%) were male, and 32 (19.3%) were female. Women had a higher mean body mass index than men (40.2 vs 36.6, p = 0.01), while age, comorbidity burden, and median Fournier's Gangrene Severity Index were similar. Median length of stay (11 vs 12 days), 30-day readmission (30.6% vs 37.5%), in-hospital mortality (8.2% vs 9.4%), and 30-day mortality (12.7% vs 9.4%) did not differ significantly between sexes. Higher severity scores predicted death or prolonged hospitalization in both sexes.

Conclusions: In this multi-hospital cohort, women with FG had disease severity and short-term outcomes broadly similar to those of men. These findings suggest that illness severity, rather than sex alone, is the more important driver of outcome and support maintaining the same diagnostic urgency and treatment intensity for all patients with suspected FG.