Effect of Time to Surgery on Surgical Site Infection in Open Distal Radius Fractures: A Review of the ACS Trauma Quality Improvement Program Database.

IF 1.8 Q2 ORTHOPEDICS HAND Pub Date : 2024-12-25 DOI:10.1177/15589447241305422
Walter Sobba, Lawrence J Lin, Gerardo E Sanchez-Navarro, Jadie De Tolla, Omri Ayalon, Jacques H Hacquebord
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Abstract

Introduction: Managing open distal radius fractures (DRFs) poses challenges. While preventing surgical site infection (SSI) involves prompt antibiotic administration and thorough irrigation and debridement, the impact of urgent intervention on reducing postoperative infection rates is debated. We hypothesize that timing of surgery does not significantly affect the incidence of SSI in open DRF treated within or after 24 hours from time of injury.

Methods: We retrospectively analyzed the American College of Surgeons Trauma Quality Improvement Program from 2011 to 2021. We focused on outcome variables, including superficial SSI and deep SSI or osteomyelitis. To evaluate the relationship between time to operative intervention and SSI rates, we employed least absolute shrinkage and selection operator and multivariate regression models, adjusting for patient-specific factors and injury severity.

Results: A total of 14 486 patients were included. Regression modeling demonstrated a 23% increase in the odds of deep SSI with each 1-day delay in surgery (P = .010). However, no association was found between time to surgery and superficial SSI (odds ratio [OR] = 0.96, P = .768). Injury severity score (ISS) was associated with increased odds of superficial SSI (OR = 1.06, P < .001) and deep SSI (OR = 1.06, P < .001) while diabetes (OR = 3.56, P = .013) was significantly associated with increased rates of superficial SSI.

Conclusions: Extended time to surgery correlates with a modest rise in deep SSI incidence in open DRF. However, there was no heightened risk of superficial SSI in patients with delayed surgery. Polytrauma, alcohol use disorder, and diabetes were linked to elevated SSI rates in open DRF.

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手术时间对开放性桡骨远端骨折手术部位感染的影响:对ACS创伤质量改善计划数据库的回顾
导言:桡骨远端开放性骨折(DRFs)的治疗面临挑战。虽然预防手术部位感染(SSI)涉及及时使用抗生素和彻底冲洗和清创,但紧急干预对降低术后感染率的影响仍存在争议。我们假设手术时间对开放性DRF在受伤后24小时内或24小时后治疗的SSI发生率没有显著影响。方法:回顾性分析2011年至2021年美国外科医师学会创伤质量改善项目。我们关注结果变量,包括浅表SSI和深部SSI或骨髓炎。为了评估手术干预时间与SSI发生率之间的关系,我们采用了最小绝对收缩和选择算子和多元回归模型,调整了患者特定因素和损伤严重程度。结果:共纳入14 486例患者。回归模型显示,手术每延迟1天,发生深部SSI的几率增加23% (P = 0.010)。然而,手术时间与浅表SSI之间没有关联(优势比[OR] = 0.96, P = .768)。损伤严重程度评分(ISS)与浅表SSI (OR = 1.06, P < .001)和深部SSI (OR = 1.06, P < .001)的发生率增加相关,而糖尿病(OR = 3.56, P = .013)与浅表SSI发生率增加显著相关。结论:延长手术时间与开放性DRF深部SSI发生率适度上升相关。然而,延迟手术患者发生浅表SSI的风险没有增加。多发创伤、酒精使用障碍和糖尿病与开放性DRF中SSI发生率升高有关。
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来源期刊
HAND
HAND Medicine-Surgery
CiteScore
3.30
自引率
0.00%
发文量
209
期刊介绍: HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.
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