Hakkarainen Timo W, Burkette Ikebata Nicole, Bulger Eileen, Evans Heather L
Department of Surgery, University of Washington Medical Center, Seattle, WA.
University of Washington Medical Center, Seattle, WA.
J Surg Res. 2014 Nov;192(1):143-9. doi: 10.1016/j.jss.2014.05.006. Epub 2014 May 9.
Necrotizing soft tissue infections (NSTIs) represent a devastating spectrum of disease with high case mortality and resource intensive care. Treatment consists of wide surgical debridement and often prolonged periods of intensive care unit care. Major complications are common. The severity of the disease and the aggressive treatment requirements put survivors at risk for significant long-term sequelae related to the trauma of both disease and treatment. Information about the postdischarge impact of NSTIs on survivors is extremely limited. Qualitative approaches are typically used to explore new phenomena and to capture individuals' thoughts, feelings, or interpretations of meaning and process. Therefore, qualitative methods are ideally suited for hypothesis generation to guide future quantitative study and ensure measured outcomes are patient-centered.
Semistructured interviews were conducted with survivors of NSTIs from a single regional referral center. Stratified purposive sampling was used to select interview candidates based on severity of illness. Descriptive thematic analysis was performed to identify major themes described by the patients.
Interviews with 18 survivors identified three primary domains of experience: (1) individual factors, (2) relational factors, and (3) societal factors. These domains were split into the following two categories: factors effecting the disease process and recovery, and factors that were outcomes of the disease process. Each category yielded between one and seven themes. Themes identified included physical, psychological, relationship, and employment aspects.
Patient's reported quality of life was significantly affected by their disease and recovery. The results demonstrate that many outcomes of importance for patients are not easily assessed by traditional measures of outcomes. This work illustrates the multidimensional nature of recovery from critical illness, and shows that it represents a massive transition period in the lives of survivors that affects the patient, their family, and the patient's ability to interact with society. Interviews with survivors ensure that the patient voice is heard before developing tools to assess long-term outcomes.
坏死性软组织感染（NSTIs）是一类极具破坏性的疾病，病死率高，且需要大量的医疗资源。治疗方法包括广泛的手术清创，通常还需要在重症监护病房进行长时间治疗。主要并发症很常见。该疾病的严重性和积极的治疗需求使幸存者面临与疾病和治疗创伤相关的重大长期后遗症风险。关于NSTIs出院后对幸存者影响的信息极为有限。定性方法通常用于探索新现象，并捕捉个人的想法、感受或对意义及过程的解读。因此，定性方法非常适合用于提出假设，以指导未来的定量研究，并确保所测量的结果以患者为中心。
对来自单一区域转诊中心的NSTIs幸存者进行了半结构化访谈。采用分层目的抽样法根据疾病严重程度选择访谈对象。进行描述性主题分析以确定患者描述的主要主题。
对18名幸存者的访谈确定了三个主要经验领域：（1）个人因素，（2）关系因素，以及（3）社会因素。这些领域分为以下两类：影响疾病进程和康复的因素，以及作为疾病进程结果的因素。每类产生了1至7个主题。确定的主题包括身体、心理、人际关系和就业方面。
患者报告的生活质量受到其疾病和康复的显著影响。结果表明，许多对患者重要的结果不易通过传统的结果测量方法进行评估。这项工作说明了危重症康复的多维度性质，并表明它代表了幸存者生活中的一个巨大过渡期，会影响患者、其家庭以及患者与社会互动的能力。对幸存者的访谈确保在开发评估长期结果的工具之前能听到患者的声音。
