The psychosocial burden of survivorship: long-term health-related quality of life following Fournier's gangrene.

BACKGROUND

Fournier's gangrene (FG) is a life-threatening necrotizing fasciitis of the perineal and genital regions associated with high morbidity and mortality. While the Fournier's Gangrene Severity Index (FGSI) effectively predicts acute mortality, its utility in prognosticating long-term health-related quality of life (HRQoL) remains unclear. We aim to evaluate the long-term HRQoL of FG survivors using age-standardized norms, assess the predictive value of admission FGSI on long-term functional outcomes, and determine the impact of postoperative recovery duration on survivorship.

METHODS

This retrospective cross-sectional study evaluated adult FG survivors treated at a tertiary academic center over 14 years. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36). Raw scores were transformed into age-adjusted Z-scores using validated local normative data. Primary outcomes were deviations in Z-scores, Physical Component Summary (PCS), and Mental Component Summary (MCS) scores from normative baselines. Secondary outcomes evaluated the correlation of SF-36 domains with admission FGSI and time elapsed since index surgery.

RESULTS

The cohort comprised 36 long-term survivors. Survivors exhibited profound impairments in HRQoL, significantly deviating from age-matched norms across multiple domains, most notably in social functioning and emotional roles. Both mean (SD) scores of PCS [44.9 (12.9) vs. 52.6 (8.8), p = 0.001] and MCS [32.4 (13.8) vs. 51.7 (5.7), p < 0.001] were significantly lower than the general population norms. Admission FGSI demonstrated no statistical correlation with any long-term SF-36 domain (all p > 0.05). Conversely, increased time since surgery positively correlated with continuous improvements in physical functioning, social functioning, emotional roles, vitality, and bodily pain (all p < 0.05).

CONCLUSION

FGSI does not appear to predict long-term HRQoL in survivors of FG, suggesting a dissociation between acute disease severity and survivorship outcomes. While FG inflicts severe, predominantly psychosocial morbidity, patient outcomes demonstrate significant temporal improvement. These findings emphasize the need for patient-centered outcome measures beyond acute prognostic scoring systems.