Impact of severe necrotizing fasciitis on quality of life in the Netherlands

PURPOSE: Necrotizing fasciitis (NF) is a severe soft-tissue infection which can leave survivors with big and multiple disfiguring alterations to their bodies, which can negatively affect the lives of patients by causing functional limitations and altered self-perception. In this study we aim to find if NF affect (self-reported) quality of life (QoL) in patients surviving NF. METHODS: All patients with (histopathological or surgical confirmed) NF who were admitted to the intensive care unit for 24 h or more between January 2003 and December 2017 in five hospitals from the Nijmegen teaching region were included. Quality of life was measured with the SF-36 and WHOQol-BREF. These results were compared to reference populations from the Netherlands and a Australian reference population. RESULTS: 44 out of 60 patients (73.3%) who were contacted returned the surveys and were eligible for analysis. These patients showed lowered levels of quality of life on multiple domains of the SF-36: physical functioning, role limitations due to physical health, vitality and general health. The physical domain of the WHOQol-BREF showed also significant lowered levels of quality of life. CONCLUSION: NF is a severe illness with a high morbidity and mortality rate. This study shows that patients who do survive NF have decreased (self-reported) quality of life in multiple domains with a focus on decreased physical functioning. During and after admission realistic expectations should be discussed and there should be more attention to signs of permanent disability. That way extra support by a physiotherapist or social worker can be provided.