O31 – Health-Related Quality of Life Among Necrotizing Soft Tissue Infection Survivors and Clinical Predictors of Poor Outcome
Author(s):
Background: Necrotizing Soft Tissue Infection (NSTI) is a devastating diseases process with high morbidity and mortality. Treatment consists of wide surgical debridement and often, prolonged periods of ICU care. NSTI survivors are at risk for significant sequelae related to both disease and treatment. Information about the health-related quality of life (HRQOL) for NSTI survivors and clinical determinants of outcome is limited.
Hypothesis: Survivors of NSTI will have reduced health-related quality of life (HRQOL). Clinical factors related to extent of surgical treatment, disease complications, and patient comorbidities will help predict outcomes.
Methods: Retrospective cohort analysis of patients treated at a regional referral center for NSTI from 2007-2011. Patients were surveyed using the Short Form 36 (V2) between 22 and 73 months following admission. Additional information about return to prior employment, depression and PTSD symptoms was collected. Logistic regression analysis identified patient and clinical factors associated with poor outcome.
Results: Of 345 patients discharged after treatment for NSTI, 279 were contacted. Surveys of 202 survivors (73% response rate) demonstrated lower summary scores for physical (35.1, 95%CI 27.2-43.0, p=<0.001) and mental (34.3 [95%CI 29.8-38.8], p<0.001) domains compared to the general population. Sub-scores were lower in all eight domains. There was a high incidence of depression (39% [95%CI 19-59%]) and PTSD symptoms (42% [95%CI 18-64%]). 48% (95% CI 37-59%) of patients were unable to return to previous level of employment. Upper extremity amputation, >5 debridements, >10 ICU days, renal failure without return of function prior to discharge, and/or involvement of the hand or face were independently associated with poor HRQOL. Wound coverage procedure, <3 debridements, and involvement of the trunk or perineum were independently associated with better HRQOL.
Conclusions: The majority of patients treated for NSTI have reduced HRQOL 22-73 months after discharge with impairments in physical, emotional, and social functioning. There is also high prevalence of PTSD and depression symptoms among survivors. A large proportion of survivors are unable to return to previous employment. Patient and clinical factors associated with long-term HRQOL and function may allow targeted follow-up and intervention with patients at high risk of poor outcomes.