Covid-19對Fournier's gangrene的影響：我們從中學到什麼？

徐任廷¹、鐘旭東¹、歐正峰¹

¹亞東紀念醫院 外科部 泌尿科

The Impact of COVID-19 on the Management of Fournier's Gangrene: What have we learned?

Jen-Ting Hsu¹, Shiu-Dong Chung¹, Chin fong Au¹

Division of Urology¹ Department of Surgery, Far Eastern Memorial Hospital, New Taipei City

Introduction & Objectives

The COVID-19 pandemic has raised questions about managing Fournier's gangrene, a rare but potentially life-threatening infection. We aim to provide a concise overview of key findings during the COVID-19 era.

Materials & Methods

We collected data from 105 Fournier's gangrene patients in our hospital from 2006 to 2023. These patients were divided into two groups: the COVID-19 era(December 2019 to December 2022) and the non-COVID-19 era. We assessed their condition with Fournier Gangrene Severity Index(FGSI) and compared survival rates, length of hospital stay, time from symptoms to admission, the number of surgical debridement, and risk factors. Regression analysis identified factors correlated with mortality rates and hospital stays.

Results

Over the past 18 years, a total of 105 patients were included in our study. The number of individuals in the Covid-19 era group and the non-Covid-19 era group was 29 and 76, respectively. Fournier’s Gangrene Severity Index (FGSI) showed no significant differences between the Covid-19 era(mean=5.6) and non-Covid-19 era groups(mean=5.9)(p=0.667). Similarly, there was no statistical significance in mortality rates between these two groups(p=0.696). Risk factors for the disease, including age, BMI, Diabetes mellitus (DM), chronic kidney disease (CKD), hypertension (HTN), cerebral vascular accident (CVA), and time from symptom onset to hospitalization did not exhibit significant statistical differences.

Interestingly, we observed that the length of hospital stay during the Covid-19 era (mean=17.6 days) was noticeably shorter compared to the non-Covid-19 era(mean=25.2 days)(p=0.045). Additionally, the number of times surgical debridement was performed during the Covid-19 era(mean=2.2) was lower than in the non-Covid-19 era(mean=3.1)(p=0.003). In multivariate analysis, the frequency of surgical debridement was strongly correlated with the length of hospital stay(OR=1.57, 95%CI {1.127-2.189}, p=0.008), but it did not show a significant association with mortality rates(OR=0.949, 95%CI {0.651-1.382}, p=0.785).

Conclusions

Despite reduced healthcare capacity during the COVID-19 pandemic, lower surgical debridement frequency does not increase mortality rates in treating Fournier's gangrene. In fact, it leads to shorter hospital stays.