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Risk Factors for Increased Length of Stay in Hand Infections
John Fowler; Mitchell Maltenfort; Asif M. Ilyas, MD;
Thomas Jefferson University

Background: Hand infections are a significant source of patient morbidity and demand considerable hospital resources. Infections due to methicillin resistant staphylococcus aureus (MRSA) have been found in previous studies to result in increased length of stay (LOS). The purpose of this study is to determine the risk factors for increased LOS in surgically treated hand infections.

Methods: All patients at an urban academic medical center who underwent surgical treatment of a hand infection from 2005 to 2010 were identified. Inclusion criteria included: 1) age 18-89; 2) underwent incision and debridement (I&D) with a culture performed; and 3) medical records were available for review. The record search identified 1507 patients who underwent an I&D for a hand infection and 464 (30.8%) had positive cultures. Infections were characterized by location and type. Demographic data, medical comorbidities, intravenous drug abuse (IVDA) status, bacterial culture, and length of stay were recorded.

Results: The most common bacteria cultured was MRSA, accounting for 251/464 (52.1%) of positive cultures. The median LOS for all hand infections was 3 days (IQR 2-5). Human bite was the most significant risk factor for increased LOS, median 4 days (IQR 3-5), with an odds ratio of 1.71 (95% CI 1.16-2.53), p = 0.007. IVDA was not a statistically significant risk factor for increased LOS, median 4 days (IQR 3-6), OR 1.16 (95% CI 0.96-1.42), p=0.13. The only comorbidity found to have a significant effect on LOS was diabetes mellitus. Patients with diabetes mellitus had a median LOS of 4 days (IQR 3-7), OR 1.24 (95% CI 1.03 – 1.48). Finger abscess, felon, and paronychiawere found to be predictors of decreased LOS. Patients with MRSA infections had a median LOS of 4 days (IQR 2-5) compared to non-MRSA infections that had a median LOS of 3 days (IQR 2-5), p < 0.0001. Polymicrobial infection had a median LOS of 4 days (IQR 2-5) compared to non-polymicrobial infection with a median LOS of 0 days (IQR 0-2), p < 0.0001.

Discussion: MRSA infection, polymicrobial infection, diabetes mellitus, and human bite are risk factors for increased LOS in surgically treated hand infections. The location of the infection, specifically finger abscess, felon, and paronychia, were associated with a decreased LOS. This may be due to the more superficial location of these infections. Added vigilance is required in patients with MRSA and polymicrobial infections, as well as in patients with diabetes mellitus and human bite wounds.


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