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

Abstract

We compare Fournier gangrene in female and male patients and identify mortality-associated characteristics in both. We used National Inpatient Sample data (2016-2020) to identify Fournier gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were used to identify mortality risk factors for both cohorts. We identified 2875 female (31%) and 6451 male patients (69%) with Fournier gangrene corresponding to an estimated 14,375 (95% CI, 13,784-14,966) and 32,255 (95% CI, 31,390-33,120) cases, respectively. Female patients were more likely to die than male patients (7.1% vs 5.7%, <i>P</i> < .0001, respectively). The median incidence rates were 1.7 (interquartile range, 1.5-1.8) and 4 (interquartile range, 3.6-4.3) cases per 100,000 person-years for female and male patients, respectively. Female patients had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than male patients (<i>P</i> < .05). Non-White female patients had increased mortality odds compared with White female patients (odds ratio [OR], 1.49; 95% CI, 1.07-2.07; <i>P</i> = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both female and male patients (OR, 1.02; 95% CI, 1-1.04; <i>P</i> = .034 vs OR, 1.03; 95% CI, 1.01-1.05; <i>P</i> < .0001). Diabetes lowered mortality odds in female and male patients (OR, 0.68; 95% CI, 0.47-0.99; <i>P</i> = .046 vs OR, 0.54; 95% CI, 0.41-0.7; <i>P</i> < .0001). In female patients, Fournier gangrene incidence surpasses previous reports, with slightly worse outcomes compared with male patients, emphasizing the need for precise clinical assessment and early intensive interventions.