Time to surgery for open hand injuries and the risk of surgical site infection: a prospective multicentre cohort study

Abstract

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 risk ratio 1.0 [95% CI: 1.0 to 1.0]) or preoperative antibiotics (adjusted risk ratio 1.8 [95% CI: 0.2 to 13]), which were provided to 95% of patients. Skin loss increased the risk of infection (adjusted risk ratio 2.6 [95% CI: 1.3 to 5.0]). Delaying surgery for open hand injuries by 4 days does not appear to increase the risk of surgical site infection. Level of evidence: II

Can Open Hand Injuries Wait for Their Surgery in a Tertiary Hospital?

“…Yet, other factors apart from antibiotic use and time to surgery could contribute to infection rates. For example, skin loss, 17 amount of wound irrigation fluid used in the ED, 27 degree of contamination, 21,28 and age 22 could have played a role in infection rates, although we found that age was also not associated with infection rates.…”

“…Skin loss, however, increased the risk of infection. 17 Although Pavan et al found evidence to suggest a double peak for infection risk at the 6-and 24-hour mark, though this was not statistically significant when time to surgery was analyzed as a continuous variable. 19 Historically, there has been a 6-hour rule to surgical debridement for all open fractures.…”

“…This corroborated with three other studies which suggest that time to surgery is not the main predictive factor in infection rates. Angly et al found that delayed surgical treatment (6-24 hours) did not increase infection or revision rates in open nondevascularized hand injuries, 13 while Juon et al found that delayed 17 Although Pavan et al found evidence to suggest a double peak for infection risk at the 6-and 24-hour mark, though this was not statistically significant when time to surgery was analyzed as a continuous variable. 19 Historically, there has been a 6-hour rule to surgical debridement for all open fractures.…”

“…However, this critical time period is still hotly debated, and the optimal time frame has yet to be established. 14,16,17 The current practice at our tertiary hospital is for patients with open hand injuries to be managed in a semi-emergent, ambulatory setting. They are discharged from the ED, returning as a semi-emergent case for surgery in the Day Surgery Operating Theater (DSOT) in the next available slot.…”

Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study

“…Of the small number of studies that directly assess SSI in hand and wrist trauma, the risk ranges from 3 to 10 percent, reflecting similar risk as for all operative procedures. 8 , 13 , 14 , 15 There remains insufficient published data to reliably inform hand trauma patients of SSI risk.…”