Necrotizing fasciitis and the midterm outcomes after survival. (April 2019)

• Record Type: Journal Article
• Authors: Kruppa, Christiane; Hutter, Danial J; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A; Coulibaly, Marlon O
• Is Part Of: SAGE open medicine. Volume 7(2019)
• Publication Date: 2019-04
• Subjects: Necrotizing fasciitis -- infection -- surgical debridement -- Short Form 36 -- Short Musculoskeletal Function Assessment -- outcome parameters -- disability -- amputation; Medicine -- Periodicals; 610.5
• DOI: 10.1177/2050312119842433
• Languages: English
• ISSNs: 2050-3121

Abstract

Background and Aims: Radical surgical intervention is necessary to save patients' lives in cases of necrotizing fasciitis. This leads to persistent disabilities and most likely to a deteriorated quality of life. The purpose of this study was to evaluate the midterm outcomes after survival of necrotizing fasciitis. Materials and Methods: A retrospective analysis of 69 patients, treated for necrotizing fasciitis between 2003 and 2012. The patients were identified using the International Classification of Diseases (10th Revision) code M 72.6. Of the 50 survivors, 22 patients completed the Short Form 36 and Short Musculoskeletal Function Assessment questionnaires as a postal survey. The follow-up averaged 59 months (range: 6–128 months). Results: The average age at the time of necrotizing fasciitis was 60.0 years. The body mass index average was 29.7. The patients had a significantly decreased physical component summary score of 33.3 compared to a normative group (p < 0.001) (Short Form 36). They further showed a significantly decreased dysfunction and bother indices (Short Musculoskeletal Function Assessment) (p < 0.001). An increased age (⩾70 years) was associated with an inferior role emotional (p = 0.048) and physical functioning (p = 0.011) as well as social functioning (p = 0.038) (Short Form 36). The majority of patients (16, 72.7%) complained of pain at the final follow-up and 50% of patients required an assistive device on a regular basis. Conclusion: Patients who survived necrotizing fasciitis suffer from functional impairment and changed body appearance. Assistive devices or pain medication are often required, and the patients present with significantly decreased physical, social, and emotional functioning at the midterm follow-up. The patient's age is a critical factor regarding functional or mental outcome parameters. Further research on the post-hospital course and long-term multidisciplinary care is required to improve the outcomes of these patients.