Introduction: Initial management of Fournier's Gangrene (FG) is well established. After complete debridement optimal wound management is evolving. FG wounds are either treated by secondary intention(SI) utilizing negative pressure systems (NPS) or by Delayed Primary Closure (DPC) utilizing flaps and/or grafts. DPC has a shorter length of hospitalization (LOS) and faster return to normal daily activity. We hypothesize that DPC has a lower over all cost the medical system than SI.
Methods: We assessed all cases of FG treated at our hospital system from 2016 to 2021. Patients who died from FG, were lost to follow up or deviated from our treatment protocol were excluded. We collected data regarding LOS, cost of LOS, time utilizing NPS, institution specific KCI NPS cost data from our locoregional KCI representative. A KCI NPS costs $55 per day. Each canister costs $45 and each dressing costs $60. Patients will use about 3 canisters and dressings each week of NPS therapy. Average cost per day of hospitalization is $2,000.
Results: 18 cases of DPC and 19 cases of SI met inclusion criteria. DPC average cost of LOS for DPC was $28,600 compared to $42,200 in SI group CI (-26499.85 to -700.15) p<0.05. DPC total NPS therapy cost was $500 compared to $10,305 in SI group CI (-12804.10 to -6805.90) p<0.0001. Cost of surgery for DPC was $6,000.
Conclusions: At our institution, DPC was superior to closure by SI in regards to both cost of LOS and cost of NPS therapy. Patients who underwent SI had an increased total cost of care as compared to DPC patients. Total cost of care, including cost of LOS, cost of NPS therapy and cost of DPC surgery, was increased by $17,405 for SI patients. This increased cost of SI is attributable to the associated increased length of hospital stay and increased length of time on NPS therapy. Multi-institutional prospective data is needed to confirm these findings.
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