All authors contributed to the conception, design, analysis and interpretation of data, as well as drafting and critically revising the manuscript.
Fistula in ano causes significant morbidity and affects patients’ quality of life (QOL). A validated five-point Crohn’s Disease Perianal Activity Index (CDAI) has been reported, but there is no validated QOL/disease activity measure for patients with cryptoglandular sepsis (CS).
We recruited 20 CS patients with active perianal sepsis requiring surgical intervention, who completed questionnaires of quantitative scores including the CDAI, the Fecal Incontinence Quality of Life (FIQOL), St. Mark’s Incontinence Score, and the 36-Item Short Form Health Survey (SF-36). Qualitatively, patients listed the five most significant impacts of perianal sepsis on their QOL. Disease activity was rated by the treating surgeon. The study also recruited 20 age-matched controls with no perianal disease. After analyzing each CDAI element, and using the patient and surgeon feedback, a simplified Perianal Sepsis Index (PASI) score was created.
Qualitatively, pain (100%), discharge/leakage (80%), sexual function (60%), and depression (45%) were the most commonly stated impacts by patients. There were significant differences between patients and controls in the CDAI (9.8 vs. 0) and St. Mark’s scores (7.7 vs. 0.5), as well as in three domains of the FIQOL and SF-36 (p > 0.0I). After analyzing each CDAI element, patients were inaccurate in coding the type of perianal disease and degree of induration compared with their treating surgeon’s assessment. Removing disease type and degree of induration created a simplified PASI score. There were significant differences between patients and controls regarding CDAI and PASI scores (p < 0.05) but not St. Mark’s, FIQOL or SF-36 scores.
The PASI score offers a method of self-quantifying the impact of perianal sepsis on QOL.