Post-operative quality of life in patients with necrotizing fasciitis: a report from a ten year institutional cohort.

PURPOSE: Necrotizing fasciitis (NF) is a severe orthopaedic emergency. While surgical management and critical care have improved survival, long-term quality of life (QoL) for survivors remains poorly understood. This study evaluates patient-reported QoL post-surgery using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and 26-Item Short Form Survey (SF-36), examining their relationship with initial disease severity as measured by the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score.

METHODS

This cross-sectional study included 21 patients treated surgically for NF between 2015-2025, each with ≥ one year of follow-up. LRINEC scores were calculated from preoperative labs, EQ-5D-5L responses converted to U.S. utility indices, and SF-36 scored on a 0-100 scale. Associations between LRINEC and QoL domains were assessed with Spearman correlations.

RESULTS

Mean follow-up was 5.4 years (SD 3.7). The mean EQ-5D-5L utility index was 0.6 (SD 0.4). Pain/discomfort was the most reported problem overall (76.2%), with moderate-severe symptoms most common in pain/discomfort (57.1%) and mobility (47.6%), and least common in anxiety/depression (28.6%). SF-36 median domain scores were worst in Role-Physical (25.0/100) and best in Role-Emotional (100/100). The mean LRINEC score was 4.6 (SD 3.0), with no statistically significant correlation to any QoL measure in this cohort (P > 0.05).

CONCLUSIONS

Among responding NF survivors, the observed long-term health status was characterized by frequent pain, mobility problems, and physical role limitations, while emotional domains had comparatively better scores across both instruments. No statistically significant association between LRINEC score at presentation and QoL was detected in this cohort. These findings highlight the potential for meaningful mental health recovery and underscore the importance of physical rehabilitation as part of comprehensive long-term care.