Predicting Mortality in Fournier Gangrene and Validating the Fournier Gangrene Severity Index: Our Experience with 50 Patients in a Tertiary Care Center in India.

OBJECTIVE: To identify factors that dictate morbidity and mortality in patients with Fournier's Gangrene and validate the Fournier gangrene severity index (FGSI). MATERIALS AND METHODS: We prospectively studied 50 patients with FG from January 2016 to December 2016 pertaining to their presenting signs, intraoperative findings, and postoperative wound management and outcome. We also checked the power of the FGSI to predict the outcome of the patients in terms of mortality. Receiver operating characteristic curve was used to determine the optimum cutoff of FGSI score to predict mortality. Principle component analysis was performed to check for the possibility of reduction in the number of factors included in the FGSI. RESULTS: The mean age at presentation was 53 ± 16 years with a mortality rate of 24%. Factors associated with mortality were increasing age (p = 0.0001), presence of diabetes (p = 0.002), bed-ridden status (p = 0.001), alcoholic liver disease (p = 0.005), altered international normalized ratio (p > 0.005), late presentation (p = 0.001), and a FGSI score of > 9 at admission (p = 0.004). The mean FGSI score among survivors was 4.39 ± 3.80 compared to 14.22 ± 3.93 among those who died. The area under the curve FGSI score to predict mortality at a cutoff of 9 was 0.961 (95% CI 0.910-1.000). CONCLUSION: Increasing age, diabetes, alcoholic liver disease, bed-ridden status, delayed hospital presentation, and an altered international normalized ratio at presentation are associated with higher mortality in FG. The FGSI at admission should be used to identify patients with serious prognosis requiring intensive care.

Chemoport Insertion-Less Is More.

Implantable chemoport is a very useful device for long-term venous access for infusion of chemotherapeutic drugs and other agents. There are few studies from resource poor countries reporting complications of chemoport. The aim of the present study is to evaluate the feasibility of chemoport insertion without image guidance and by closed technique without direct visualisation of a major vein (mainly IJV) and to study the complications associated with the procedure. This was a prospective observational study which analysed 263 patients who underwent chemoport insertion. The medical records of these patients were analysed for the patient characteristics, diagnosis, port-related complications, and their management. A total of 263 patients who were harbouring either locoregionally advanced or metastatic tumour requiring either chemotherapy or targeted treatment or both were included in the study. In total, 133 (50.57%) were female patients and 130 were male patients (49.43%). A total of 236 patients (89.73%) underwent port insertion procedures under local anaesthesia. None of the patients had any major intra-operative complications. Postoperatively, 4 patients (1.52%) were found to have port catheter malposition; 3 out of this 4 were corrected under IITV guidance as a second procedure under local anaesthesia only. One patient (0.38%) required formal removal and replacement of port. Four patients (1.52%) developed IJV thrombosis requiring port removal and anti-coagulation. One patient (0.38%) developed thrombus in the right atrium. There were 2 port site infections (0.74%) requiring port removal (SSI cat. 5). Low complication rates of port insertion were observed in the present, large, prospective study. Complication rates may be further reduced by using a well-designed procedure, experienced surgeons, an aseptic environment, ultrasound-guided puncture, and fluoroscopy with contrast media. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-020-01265-6.