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J Hand Microsurg 2022; 14(03): 188-196
DOI: 10.1055/s-0040-1710200
Original Article

Survival and Health-Related Quality of Life after Hospitalization for Necrotizing Soft Tissue Infections of the Upper Extremity: A Long-Term Outcome Study

Femke Nawijn 
1   Department of Surgery, University Medical Center Utrecht, CX Utrecht, The Netherlands
2   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, United States
,
Svenna H. W. L. Verhiel
2   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, United States
,
Juliette Nierich
2   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, United States
,
Kyle R. Eberlin
3   Division of Plastic and Reconstructive Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, United States
,
Falco Hietbrink
1   Department of Surgery, University Medical Center Utrecht, CX Utrecht, The Netherlands
,
Neal C. Chen
2   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, United States
› Author Affiliations Funding None.
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Abstract

Introduction The main aim of the study was to investigate the survival and health-related quality of life (HRQoL) after hospitalization for necrotizing soft tissue infections (NSTIs) of the upper extremity.

Materials and Methods A retrospective study with long-term follow-up of patients surviving NSTIs of the upper extremity was performed. Survival and HRQoL after hospital discharge were the primary outcomes. The HRQoL was measured using the 36-item Short Form (SF-36), EuroQoL-5D-5L (EQ-5D), Quick Disability of Shoulder, Arm and Hand (QuickDASH), and numeric rating scales (NRS) for satisfaction with appearance and pain.

Results A median of 6.5 years after hospitalization, 81% of the 108 patients survived. The response rate was 45% (n = 38). The SF-36 score was 80 (interquartile range [IQR]: 58–91), the EQ-5D score 1.4 (IQR: 1.2–2.2), the EuroQoL-Visual Analog Scale score 77 (IQR: 67-90), the QuickDASH score 13.6 (IQR: 2.3-30.7), the NRS for satisfaction with appearance 8 (IQR: 7–9), and NRS for pain 1 (IQR: 0-5).

Conclusion Six-and-a-half years after the NSTI, 81% of the patients were still alive. General health prior to the NSTI mainly influenced the risk at secondary mortality. In surviving patients, the HRQoL varied widely, but was adversely affected by female sex, intravenous drug use, NSTI type I or III, and longer length of hospital stay.

Keywords

necrotizing soft tissue infection - necrotizing fasciitis - quality of life - survival - upper extremity

Supplementary Material



Publication History

Article published online:
06 May 2020

© 2020. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014; 51 (08) 344-362
    CrossrefPubMedGoogle Scholar
  • 2 Krieg A, Dizdar L, Verde PE, Knoefel WT. Predictors of mortality for necrotizing soft-tissue infections: a retrospective analysis of 64 cases. Langenbecks Arch Surg 2014; 399 (03) 333-341
    CrossrefPubMedGoogle Scholar
  • 3 Ellis Simonsen SM, van Orman ER, Hatch BE. et al Cellulitis incidence in a defined population. Epidemiol Infect 2006; 134 (02) 293-299
    CrossrefPubMedGoogle Scholar
  • 4 Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis 2014; 18 (02) 137-143
    CrossrefPubMedGoogle Scholar
  • 5 Nawijn F, Wassenaar EC, Smeeing DPJ. et al Exhaustion of the immune system by Group A Streptococcus necrotizing fasciitis: the occurrence of late secondary infections in a retrospective study. Trauma Surg Acute Care Open 2019; 4 (01) e000272
    CrossrefPubMedGoogle Scholar
  • 6 Nawijn F, Verhiel S, Lunn K, Eberlin K, Hietbrink F, Chen NC. Factors associated with mortality and amputation caused by necrotizing soft tissue infections of the upper extremity: a retrospective cohort study. World J Surg 2019; 1-11
    PubMedGoogle Scholar
  • 7 Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg 2020; 15 (04) 4
    CrossrefPubMedGoogle Scholar
  • 8 Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg 2014; 101 (01) e119-e125
    CrossrefPubMedGoogle Scholar
  • 9 Fernando S, Tran A, Cheng W. et al Necrotizing soft tissue infections: diagnostic accuracy of physical examination, imaging, and LRINEC Score. Ann Surg 2019; 269 (01) 58-65
    CrossrefPubMedGoogle Scholar
  • 10 Anaya DA, Bulger EM, Kwon YS, Kao LS, Evans H, Nathens AB. Predicting death in necrotizing soft tissue infections: a clinical score. Surg Infect (Larchmt) 2009; 10 (06) 517-522
    CrossrefPubMedGoogle Scholar
  • 11 Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR. Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg 2007; 119 (06) 1803-1807
    CrossrefPubMedGoogle Scholar
  • 12 Faraklas I, Yang D, Eggerstedt M. et al A multi-center review of care patterns and outcomes in necrotizing soft tissue infections. Surg Infect (Larchmt) 2016; 17 (06) 773-778
    CrossrefPubMedGoogle Scholar
  • 13 Light TD, Choi KC, Thomsen TA. et al Long-term outcomes of patients with necrotizing fasciitis. J Burn Care Res 2010; 31 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 14 Gawaziuk JP, Strazar R, Cristall N, Logsetty S. Factors predicting health-related quality of life following necrotizing fasciitis. J Plast Reconstr Aesthet Surg 2018; 71 (06) 857-862
    CrossrefPubMedGoogle Scholar
  • 15 de Putter CE, Selles RW, Haagsma JA. et al Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome. Injury 2014; 45 (11) 1752-1758
    CrossrefPubMedGoogle Scholar
  • 16 Schecter W, Meyer A, Schecter G, Giuliano A, Newmeyer W, Kilgore E. Necrotizing fasciitis of the upper extremity. J Hand Surg Am 1982; 7 (01) 15-20
    CrossrefPubMedGoogle Scholar
  • 17 Uehara K, Yasunaga H, Morizaki Y, Horiguchi H, Fushimi K, Tanaka S. Necrotising soft-tissue infections of the upper limb: risk factors for amputation and death. Bone Joint J 2014; 96-B (11) 1530-1534
    CrossrefPubMedGoogle Scholar
  • 18 Vandenbroucke JP, von Elm E, Altman DG. et al STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12 (12) 1500-1524
    CrossrefPubMedGoogle Scholar
  • 19 Hietbrink F, Bode LG, Riddez L, Leenen LPH, van Dijk MR. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg 2016; 11 (01) 51
    CrossrefPubMedGoogle Scholar
  • 20 United States Goverment. 41 CFR 61–250.2 - What definitions apply to this part? [Internet]. Code of Federal Regulations. 2005 [cited 2018 Dec 1]
    PubMed
  • 21 Thom D. Appraising current methods for preclinical calculation of burn size - a pre-hospital perspective. Burns 2017; 43 (01) 127-136 [Internet]
    CrossrefPubMedGoogle Scholar
  • 22 Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32 (07) 1535-1541
    CrossrefPubMedGoogle Scholar
  • 23 Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg 2014; 1 (36) 36
    CrossrefPubMedGoogle Scholar
  • 24 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30 (06) 473-483
    CrossrefPubMedGoogle Scholar
  • 25 Grassi M, Nucera A. European Community Respiratory Health Study Quality of Life Working Group. Dimensionality and summary measures of the SF-36 v1.6: comparison of scale- and item-based approach across ECRHS II adults population. Value Health 2010; 13 (04) 469-478
    PubMedGoogle Scholar
  • 26 Jenkinson C. Comparison of UK and US methods for weighting and scoring the SF-36 summary measures. J Public Health Med 1999; 21 (04) 372-376
    CrossrefPubMedGoogle Scholar
  • 27 Herdman M, Gudex C, Lloyd A. et al Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20 (10) 1727-1736
    CrossrefPubMedGoogle Scholar
  • 28 Szende A, Williams A. Measuring Self-Reported Population Health: An International Perspective based on EQ-5D. 1st ed: Springmed Publishing Ltd; 2014
    PubMed
  • 29 Kennedy CA, Beaton DE, Smith P. et al Measurement properties of the QuickDASH (disabilities of the arm, shoulder and hand) outcome measure and cross-cultural adaptations of the QuickDASH: a systematic review. Qual Life Res 2013; 22 (09) 2509-2547
    CrossrefPubMedGoogle Scholar
  • 30 Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14 (07) 798-804
    CrossrefPubMedGoogle Scholar
  • 31 Mira JC, Brakenridge SC, Moldawer LL, Moore FA. Persistent Inflammation, Immunosuppression and Catabolism Syndrome. Crit Care Clin 2017; 33 (02) 245-258
    CrossrefPubMedGoogle Scholar
  • 32 Timmers TK, Verhofstad MH, Moons KG, Leenen LP. Long-term survival after surgical intensive care unit admission: fifty percent die within 10 years. Ann Surg 2011; 253 (01) 151-157
    CrossrefPubMedGoogle Scholar
  • 33 Hakkarainen TW, Burkette Ikebata N, Bulger E, Evans HL. Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections. J Surg Res 2014; 192 (01) 143-149
    CrossrefPubMedGoogle Scholar
  • 34 Suijker J, de Vries A, de Jong VM, Schepers T, Ponsen KJ, Halm JA. Health-Related Quality of Life Is Decreased After Necrotizing Soft-Tissue Infections. J Surg Res 2020; 245: 516-522
    CrossrefPubMedGoogle Scholar
  • 35 Pikturnaite J, Soldin M. Impact of necrotising fasciitis on quality of life: a qualitative analysis. Burns 2014; 40 (05) 848-851
    CrossrefPubMedGoogle Scholar
  • 36 Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001; 33 (01) 6-15
    CrossrefPubMedGoogle Scholar
  • 37 Fischer JA, Conrad S, Clavarino AM, Kemp R, Najman JM. Quality of life of people who inject drugs: characteristics and comparisons with other population samples. Qual Life Res 2013; 22 (08) 2113-2121
    CrossrefPubMedGoogle Scholar
  • 38 Krieg A, Röhrborn A, Schulte Am Esch J. et al Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome. Eur J Med Res 2009; 14 (01) 30-36
    CrossrefPubMedGoogle Scholar