{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:38:21Z","timestamp":1777448301802,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the impact of transferring patients with Fournier's gangrene (FG) to a tertiary referral hospital (TRH) on survival and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of FG cases treated at our TRH from January 2015 to January 2022. Clinicodemographic, laboratory, perioperative, and mortality data were collected. Patients were categorized into two groups: those directly presented (DP) to TRH and those transferred for treatment (TT) from other hospitals. Primary outcome was 30-day mortality. Secondary outcomes included 90-day, 180-day, 1-year and 2-year mortality. We employed chi-square, T-tests, and Fisher's exact tests for significance assessment. Survival was evaluated using Kaplan-Meier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      136 patients (77.9% males) were analyzed: 66.9% in the TT group (n = 91), 33.1% in DP group (n = 45), with median ages of 59.2 and 56.4, respectively,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.06. Median transfer distance: 10.6 miles, travel time: 16 minutes. No significant differences were observed in time from presentation to initial debridement (8.45 hours for TT, 7.3 hours for DP,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.57), comorbidities, or FG Severity Index. No significant differences in 30-day mortality (TT: 5.5%, DP: 4.4%, [HR = 1.53, 95% CI: 0.31, 7.57],\n                      <jats:italic>P<\/jats:italic>\n                      = 0.6), or other mortality rates (90-day: 7.7% vs 6.6%, 180-day: 14.3% vs 8.9%, 1-year: 18.7% vs 15.6%, 2-year: 20.9% vs 15.6%,\n                      <jats:italic>P<\/jats:italic>\n                      &gt; 0.05). DP had a higher rate of fast door-to-operation room (&lt;6 hours) than TT (46.7% vs 18.7%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.06), although 30-day mortality was not affected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Transfer of FG patients to a TRH was not associated with increased mortality. Due to the rarity and complexity of this disease, centralizing care might be the preferred approach in cases of regional primary presentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251331287","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T04:25:38Z","timestamp":1743567938000},"page":"1140-1148","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of a Regionalized Care Model in Treating Fournier\u2019s Gangrene"],"prefix":"10.1177","volume":"91","author":[{"given":"Sai","family":"Allu","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4130-8987","authenticated-orcid":false,"given":"Kamil","family":"Malshy","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borivoj","family":"Golijanin","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martus","family":"Gn","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Waddell","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Morgan","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Ahn","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3522-7292","authenticated-orcid":false,"given":"Amir","family":"Farah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical College of Wisconsin, Milwaukee, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Ortiz","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6602-2961","authenticated-orcid":false,"given":"Raymond","family":"Che","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kennon","family":"Miller","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline","family":"Cancian","sequence":"additional","affiliation":[{"name":"The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,4]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2009.08.090"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197205000-00010"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-022-04139-4"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","unstructured":"Malshy K Schmit S Golijanin B et al. 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