{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:04:29Z","timestamp":1755219869227,"version":"3.43.0"},"reference-count":30,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"unspecified","delay-in-days":218,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2732494X25100843_as1\">\n\t    <jats:title>Background:<\/jats:title>\n\t    <jats:p>Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) of the perineum. Recent retrospective studies from quaternary centers suggest improved outcomes and a potentially less aggressive clinical course for FG than non-perineal NSTIs. However, comprehensive nationwide data remain limited.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100843_as2\">\n\t    <jats:title>Methods:<\/jats:title>\n\t    <jats:p>This retrospective cohort study analyzed the National Inpatient Sample (2016\u20132020) to compare outcomes between FG and non-perineal NSTIs. Adult patients undergoing surgical debridement with a diagnosis of FG or NSTI were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), hospital costs, and home discharge rates. Multivariable regression analyses adjusted for patient demographics, comorbidities, and hospital characteristics.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100843_as3\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>A total of 5,007 FG and 24,782 non-perineal NSTI patients were identified. Crude in-hospital mortality rates were 5.8% for FG and 5.4% for non-perineal NSTIs, with stable trends observed over five years. After adjustment, no significant difference in mortality was observed (adjusted odds ratio [aOR]: 1.04; 95% CI: 0.90\u20131.20). However, FG was associated with longer LOS (adjusted mean difference: 1.99 days; 95% CI: 1.53\u20132.46) and higher hospital costs ($37,809 higher; 95% CI: $29,540\u2013$46,077). Home discharge rates were similar between groups (aOR: 0.97; 95% CI: 0.89\u20131.05).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100843_as4\">\n\t    <jats:title>Discussion:<\/jats:title>\n\t    <jats:p>Despite similar mortality rates, FG hospitalizations were associated with increased LOS and higher costs compared to non-perineal NSTIs. These findings may suggest potential nationwide disparities in FG care quality, particularly outside specialized referral centers. Further research is needed to understand if standardized care pathways tailored to FG may optimize management and reduce resource utilization.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/ash.2025.10084","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T10:21:03Z","timestamp":1754562063000},"source":"Crossref","is-referenced-by-count":0,"title":["Fournier gangrene is associated with increased length of stay and higher healthcare costs compared to non-perineal necrotizing soft tissue infections: a retrospective analysis of the National Inpatient Sample (2016\u20132020)"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-3955","authenticated-orcid":false,"given":"Hayato","family":"Mitaka","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0130-4335","authenticated-orcid":false,"given":"Kristen","family":"McQuerry","sequence":"additional","affiliation":[{"name":"University of Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0759-8917","authenticated-orcid":false,"given":"Kelsey","family":"Karnik","sequence":"additional","affiliation":[{"name":"University of Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7577-7688","authenticated-orcid":false,"given":"Alexandre R.","family":"Marra","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein"},{"name":"Department of Internal Medicine, University of Iowa Health Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1646-9930","authenticated-orcid":false,"given":"Toshio","family":"Naito","sequence":"additional","affiliation":[{"name":"Juntendo University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5041-0708","authenticated-orcid":false,"given":"Patrick","family":"Ten Eyck","sequence":"additional","affiliation":[{"name":"University of Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8273-9057","authenticated-orcid":false,"given":"Paul G.","family":"Auwaerter","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5452-5334","authenticated-orcid":false,"given":"Yuji","family":"Yamada","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4751-6859","authenticated-orcid":false,"given":"Takaaki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"University of Kentucky College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"S2732494X25100843_ref15","doi-asserted-by":"crossref","first-page":"E1096","DOI":"10.1111\/j.1464-410X.2012.11291.x","article-title":"Impact of surgical intervention timing on the case fatality rate for Fournier\u2019s gangrene: an analysis of 379 cases","volume":"110","author":"Sugihara","year":"2012","journal-title":"BJU Int"},{"key":"S2732494X25100843_ref28","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1089\/sur.2020.099","article-title":"Estimating the impact of necrotizing soft tissue infections in the United States: incidence and re-admissions","volume":"22","author":"May","year":"2021","journal-title":"Surg Infect (Larchmt)"},{"key":"S2732494X25100843_ref17","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.amjsurg.2012.08.008","article-title":"Impact of timing of surgery on outcome of Vibrio vulnificus-related necrotizing fasciitis","volume":"206","author":"Chao","year":"2013","journal-title":"Am J Surg"},{"key":"S2732494X25100843_ref30","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"S2732494X25100843_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)46485-6"},{"key":"S2732494X25100843_ref2","first-page":"149","article-title":"Fourniers gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance","volume":"59","author":"Stephens","year":"1993","journal-title":"Am Surg"},{"key":"S2732494X25100843_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2010.07.041"},{"key":"S2732494X25100843_ref27","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1089\/sur.2023.037","article-title":"Short versus long antibiotic duration for necrotizing soft tissue infection: a systematic review and meta-analysis","volume":"24","author":"Lyons","year":"2023","journal-title":"Surg Infect (Larchmt)"},{"key":"S2732494X25100843_ref8","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002636"},{"key":"S2732494X25100843_ref10","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.surg.2012.11.026","article-title":"Contemporary trends in necrotizing soft-tissue infections in the United States","volume":"153","author":"Psoinos","year":"2013","journal-title":"Surgery"},{"key":"S2732494X25100843_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00583-7"},{"key":"S2732494X25100843_ref24","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2020.436"},{"key":"S2732494X25100843_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.06.036"},{"key":"S2732494X25100843_ref18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4103\/0974-2700.173868","article-title":"Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: a single academic center experience","volume":"9","author":"Hadeed","year":"2016","journal-title":"J Emerg Trauma Shock"},{"key":"S2732494X25100843_ref5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.urology.2016.09.021","article-title":"Contemporary trends in the inpatient management of Fournier\u2019s gangrene: predictors of length of stay and mortality based on population-based sample","volume":"102","author":"Furr","year":"2017","journal-title":"Urology"},{"key":"S2732494X25100843_ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2005.03622.x"},{"key":"S2732494X25100843_ref19","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/TA.0000000000001857","article-title":"Optimal timing of initial debridement for necrotizing soft tissue infection: a practice management guideline from the eastern association for the surgery of trauma","volume":"85","author":"Gelbard","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"S2732494X25100843_ref26","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2022.011"},{"key":"S2732494X25100843_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2004.03.049"},{"key":"S2732494X25100843_ref21","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1001\/archsurg.140.2.151","article-title":"Predictors of mortality and limb loss in necrotizing soft tissue infections","volume":"140","author":"Anaya","year":"2005","journal-title":"Arch Surg"},{"key":"S2732494X25100843_ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0300738"},{"key":"S2732494X25100843_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001562"},{"key":"S2732494X25100843_ref13","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/00000658-199505000-00013","article-title":"Determinants of mortality for necrotizing soft-tissue infections","volume":"221","author":"McHenry","year":"1995","journal-title":"Ann Surg"},{"key":"S2732494X25100843_ref9","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1089\/sur.2022.294","article-title":"Defining the optimal antibiotic duration in necrotizing skin and soft tissue infections: clinical experience from a quaternary referral center","volume":"24","author":"Horn","year":"2023","journal-title":"Surg Infect (Larchmt)"},{"key":"S2732494X25100843_ref29","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: a severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit Care Med"},{"key":"S2732494X25100843_ref14","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00134-008-1373-4","article-title":"Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management","volume":"35","author":"Boyer","year":"2009","journal-title":"Intensive Care Med"},{"key":"S2732494X25100843_ref6","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2015.238"},{"key":"S2732494X25100843_ref20","doi-asserted-by":"publisher","DOI":"10.1086\/519936"},{"key":"S2732494X25100843_ref25","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2021.256"},{"key":"S2732494X25100843_ref16","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/j.1445-2197.2012.06251.x","article-title":"Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study","volume":"83","author":"Bucca","year":"2013","journal-title":"ANZ J Surg"}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X25100843","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T10:21:05Z","timestamp":1754562065000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X25100843\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S2732494X25100843"],"URL":"https:\/\/doi.org\/10.1017\/ash.2025.10084","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e178"}}