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The Impact of Time to Surgical Debridement on Infection and Reoperation Rates in Open Upper Limb Fractures
Harry Beale1,2, William Kirk2, Waseem Hasan2
1Imperial College London, London, United Kingdom; and.
Objective:
To examine the association between debridement timing and infection, readmission, and reoperation in open upper-limb fractures.
Design:
Retrospective cohort study.
Setting:
Academic Level 1 trauma center.
Patient Selection Criteria:
All patients with open upper limb fractures involving the humerus (AO/OTA 1), radius or ulna (AO/OTA 2), scapula (AO/OTA 14), or clavicle (AO/OTA 15) treated at a single academic Level I trauma center between 2014 and 2023 were included. Exclusions were isolated hand injuries, primary amputation, death before surgery, and incomplete records.
Outcome Measures And Comparisons:
Patients were grouped based on time to debridement: ≤24 hours, 24-48 hours, and >48 hours. Multivariable logistic regression models adjusted for American Society of Anesthesiologists grade, Gustilo-Anderson classification, and Injury Severity Score (ISS) evaluated the association between timing and 30-day readmission, 90-day readmission, 1-year reoperation, and infection.
Results:
The study included 297 patients [mean age 44.7 years (SD 22.5); 66.9% male]. Baseline demographics were similar across time-to-debridement groups (≤24 hours, n = 154; 24-48 hours, n = 83; >48 hours, n = 60) with no significant differences in age, sex, or ISS (all P > 0.05). Debridement within 24 hours occurred in 154 of 297 patients (51.9%), and 60 of 297 patients (20.2%) experienced delays >48 hours. Outcome rates were 30-day readmission in 18 of 297 patients (6.1%), 90-day readmission in 21 of 297 patients (7.1%), reoperation within 1 year in 44 of 297 patients (14.8%), and postoperative infection in 13 of 297 patients (4.4%). No statistically significant association was observed between debridement timing and 30-day readmission ( P = 0.72), 90-day readmission ( P = 0.83), 1-year reoperation ( P = 0.11), or infection ( P = 0.39).
Conclusions:
Within the studied intervals (≤24, 24-48, and >48 hours), debridement timing up to and including delays >48 hours was not significantly associated with readmission, reoperation within 1 year, or postoperative infection in open upper limb fractures.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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