Time to Surgery for Open Hand Injuries and the Risk of Surgical Site Infection: A Prospective Multicentre Cohort Study
James Davies, MBChB BSc1; Tobias Roberts, BSc MBBS2; David Mather, BM BCh MSc MA FRCSEd(Plast)2; Daniel J Thornton, MBChB MRCS MPhil FRCS(Plast) Diploma(Hand Surgery)1; Ryckie George Wade, MBBS MSc MClinEd MRCS FHEA3; Richard Limb, BMSc BMBS MRCS2
1Leeds General Infirmary, Leeds, United Kingdom; 2Pinderfields General Infirmary, Wakefield, United Kingdom; 3Department of Plastic and Reconstructive Surgery, University of Leeds, Leeds, United Kingdom
Whether delaying surgery increases the risk of infection in open hand injuries is an important but unresolved topic.
This prospective cohort study included 983 consecutive adults with open hand injuries treated surgically over 1 year. The risk ratio (RR) for surgical site infection was estimated by logistic regression.
The median time from injury to surgery was 20 hours (range, 4 -90). Forty-one patients (4%) developed an infection. The risk of infection was not affected by the time to surgery (adjusted RR 1.0 [95% CI: 1.0 to 1.0]; Figure 1). Skin loss increased the risk of infection (adjusted RR 2.6 [95% CI: 1.3 to 5.0]). The risk of infection was not reduced by preoperative antibiotics (adjusted RR 1.8 [95% CI: 0.2 to 13]) which were provided to 95% of patients; further, there was no significant interaction between the time to surgery and provision of preoperative antibiotics (adjusted RR 1.0 [95% CI: 1.0 to 1.0]) which means that preoperative antibiotics did not affect the risk of infection after surgery. Furthermore, preoperative antibiotics did not change the risk of SSI in patients with diabetes (Figure 2), different mechanisms of injury (Figure 3) or skin loss (Figure 4).
Delaying surgery for open hand injuries by up to 4 days does not appear to increase the risk of surgical site infection.
Figure 1. Boxplot of the incidence of surgical site infection by hours from injury to surgery.
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