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Minerva Urologica e Nefrologica 2020 April;72(2):223-8

DOI: 10.23736/S0393-2249.20.03696-6


language: English

Hyperbaric oxygen therapy reduces mortality in patients with Fournier’s Gangrene. Results from a multi-institutional observational study

Massimiliano CRETA 1, Nicola LONGO 1, Davide ARCANIOLO 2, Riccardo GIANNELLA 3, Tommaso CAI 4, Annarita CICALESE 5, Cosimo DE NUNZIO 6, Giovanni GRIMALDI 7, Virgilio CICALESE 5, Marco DE SIO 2, Riccardo AUTORINO 2, 8, 9, Estevao LIMA 10, Paolo FEDELINI 3, Mariano MARMO 11, Marco CAPECE 1, Roberto LA ROCCA 1, Andrea TUBARO 12, Ciro IMBIMBO 1, Vincenzo MIRONE 1, Ferdinando FUSCO 1

1 Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy; 2 Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy; 3 Department of Urology, A. Cardarelli Hospital, Naples, Italy; 4 Department of Urology, Santa Chiara Regional Hospital, Trento, Italy; 5 Department of Urology, A.O.R.N. “S.G. Moscati”, Avellino, Italy; 6 Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; 7 Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS, G. Pascale Foundation, Naples, Italy; 8 Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA; 9 Division of Urology, McGuire VA Medical Center, Richmond, VA, USA; 10 Department of Urology, Braga Hospital, Braga, Portugal; 11 Department of Anesthesia, Intensive Care and HBOT Unit, A. Cardarelli Hospital, Naples, Italy; 12 Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy

BACKGROUND: Evidence about the clinical benefits of Hyperbaric Oxygen Therapy (HBOT) in patients with Fournier’s Gangrene (FG) is controversial and inconclusive. We aimed to compare the mortality related to FG between patients undergoing surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT.
METHODS: We performed a retrospective multi-institutional observational case-control study. All patients admitted with diagnosis of FG from June 2009 to June 2019 were included into the study. Patients received surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. Factors associated with FG related mortality were assessed with uni-and multivariate analyses. The main outcome measure was FG related mortality.
RESULTS: A total of 161 patients with diagnosis of FG were identified. Mean FG Severity Index was 8.6±4.5. All patients had broad-spectrum parenteral antibiotic therapy. An aggressive debridement was performed in 139 (86.3%) patients. A total of 72 patients (44.7%) underwent HBOT. Mortality due to FG was observed in 32 (36.0%) of patients who do not underwent HBOT and in 14 (19.4%) of patients who underwent HBOT (P=0.01). At the multivariate analysis, surgical debridement and HBOT were independent predictors of lower mortality while higher FG Severity Index was independent predictor of higher mortality.
CONCLUSIONS: HBOT and surgical debridement are independent predictors of reduced FG related mortality.

KEY WORDS: Fournier Gangrene; Hyperbaric Oxygenation; Mortality

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