Association between SGLT2 inhibitor use and Fournier’s gangrene after genital or perineal surgery: a retrospective cohort study

Fournier’s gangrene (FG) is a rare but life-threatening infectious complication of surgery in the perineum and genital region. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been linked to genital infections in case reports, but the postoperative risk of FG in patients receiving these medications is unclear. We evaluated whether preoperative exposure to SGLT2is increases FG risk following genital or perineal surgery.

We conducted a retrospective cohort study using the TriNetX Research Network, including adults who underwent genital or perineal surgery between 2013 and 2025. Exposure was defined as any SGLT2i prescription recorded at least 5 days before surgery. Patients with prior FG or debridement for necrotizing infection were excluded. The primary outcome was FG within 1 month postoperatively; secondary outcomes included risk over 3 months and 1 year. Cohorts were balanced using propensity score matching for demographic factors and comorbidities.

Of 510,330 eligible patients, 7575 received SLGT2is and 502,755 did not. After matching, each cohort included 7572 patients. At 1 month, FG occurred in 13 (0.17%) exposed patients and 20 (0.27%) non-exposed patients (RR 0.65, 95% CI 0.32–1.30, p = 0.2). Results were similar at 3 months and 1 year. A subgroup analysis among patients with diabetes yielded results consistent with the primary analysis.

Preoperative use of SGLT2is was not associated with increased postoperative FG risk following perineal or genital surgery. If validated, these findings may reassure clinicians and patients that SGLT2i use is safe in surgical patients, though protective medication management practices may contribute to these outcomes.