The Effect of Sexual Dysfunction on Health-Related Quality of Life in Men Following Traumatic Pelvic Fractures.

BACKGROUND Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life in men. METHODS 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated post-injury health-related quality of life and sexual function. Inverse probability weighting was utilized to adjust for survey non-response. Pelvic fracture characteristics were classified based on the Orthopaedic Trauma Association (OTA) classification system. Sexual function was evaluated utilizing the International Index of Erectile Function (IIEF) and health-related quality of life (HrQOL) was evaluated utilizing the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. RESULTS After inverse probability weighting and adjustment for potential confounders, a decrease in IIEF was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (s=0.28, p=0.02). No association was identified between OTA pelvic fracture configuration and risk of post-injury erectile dysfunction (ED) (p=0.99). 53.3% of men reported persistent ED at a median of 42.6 months (IQR 28.0, 63.3) following injury. The presence of ED was independently associated with a decrease in HrQOL (s=10.92, p<0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10-years for men with ED following pelvic fracture relative to those without. CONCLUSIONS Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. LEVEL OF EVIDENCE IV, prognostic.