Sobba Walter, Lin Lawrence J, Sanchez-Navarro Gerardo E, De Tolla Jadie, Ayalon Omri, Hacquebord Jacques H
NYU Langone Health, New York, USA.
Hand (N Y). 2024 Dec 25:15589447241305422. doi: 10.1177/15589447241305422.
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.
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.
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 ( = .010). However, no association was found between time to surgery and superficial SSI (odds ratio [OR] = 0.96, = .768). Injury severity score (ISS) was associated with increased odds of superficial SSI (OR = 1.06, < .001) and deep SSI (OR = 1.06, < .001) while diabetes (OR = 3.56, = .013) was significantly associated with increased rates of superficial SSI.
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.
处理桡骨远端开放性骨折（DRF）具有挑战性。虽然预防手术部位感染（SSI）涉及及时给予抗生素以及彻底冲洗和清创，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，对于受伤后24小时内或之后接受治疗的开放性DRF，手术时机对SSI发生率没有显著影响。
我们回顾性分析了美国外科医师学会创伤质量改进项目2011年至2021年的数据。我们重点关注结局变量，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以及多变量回归模型，并对患者特异性因素和损伤严重程度进行了调整。
共纳入14486例患者。回归模型显示，手术每延迟1天，深部SSI的几率增加23%（P = 0.010）。然而，未发现手术时间与浅表SSI之间存在关联（优势比[OR] = 0.96，P = 0.768）。损伤严重程度评分（ISS）与浅表SSI（OR = 1.06，P < 0.001）和深部SSI（OR = 1.06，P < 0.001）的几率增加相关，而糖尿病（OR = 3.56，P = 0.013）与浅表SSI发生率的显著增加相关。
手术时间延长与开放性DRF深部SSI发生率的适度上升相关。然而，手术延迟的患者浅表SSI风险并未增加。多发伤、酒精使用障碍和糖尿病与开放性DRF的SSI发生率升高有关。
