Hyperbaric oxygen therapy and Fournier's gangrene: a systematic review and meta-analysis

FactsA meta-analysis demonstrated hyperbaric oxygen therapy reduces the relative risk of death in patients suffering from Fournier's gangrene.The present study has revealed no statistically significant differences in terms of hospital length of stay or the number of surgical debridements in patients with Fournier's gangrene between the hyperbaric oxygen therapy and control groups.The extant evidence supports the use of hyperbaric oxygen therapy as an ancillary measure of Fournier's gangrene following prompt surgical debridement and antimicrobial therapy, rather than as a primary treatment modality.Open QuestionsWhat are the optimal hyperbaric oxygen treatment protocols (pressure, duration, number of sessions) for patients with Fournier's gangrene?Which patient subgroups (e.g. comorbidities, infection severity) derive the most benefit from hyperbaric oxygen therapy?How does hyperbaric oxygen therapy affect resource utilization and cost-effectiveness, particularly in healthcare systems with limited hyperbaric infrastructure? Fournier's gangrene is a rare, rapidly progressive necrotizing soft tissue infection of the genitals and perineum that continues to carry a high mortality rate. Hyperbaric oxygen therapy has been proposed as an adjunctive treatment, but its efficacy remains uncertain. We conducted a systematic review and meta-analysis of studies comparing hyperbaric oxygen therapy with standard care in adults with Fournier's gangrene. A comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science identified 13 retrospective studies including 322 patients treated with hyperbaric oxygen therapy and 366 controls. Hyperbaric oxygen therapy was associated with a significantly lower mortality rate compared with control groups. Secondary outcomes, including hospital length of stay and number of debridements, showed inconsistent results and did not differ significantly between groups. These findings suggest that hyperbaric oxygen therapy may reduce mortality in patients with Fournier's gangrene and could be considered as an adjunctive therapy.