Foote, J Bone Joint Surg Am 2020 - A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

Foote, GOLIATH Investigators, et al.·J Bone Joint Surg Am·2020·62 citations·Meta-analysis

Background

Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

Methods

We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection.

Results

We identified 84 studies (18,239 patients) for the primary analysis.
In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I 2 = 30%, 84 studies, n = 18,239).
For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I 2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I 2 = 23%, 12 studies, n = 1,255).
An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time.
Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I 2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I 2 = 0%, 29 studies, n = 5,214).

Conclusions

High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

Level of evidence: Prognostic Level IV . See Instruction for Authors for a complete description of the levels of evidence. Copyright remains with the authors and publisher.

Core

A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

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A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

Foote, GOLIATH Investigators, et al.·J Bone Joint Surg Am·2020·62 citations·Meta-analysis

DOI·PubMed

Background

Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

Methods

Results

We identified 84 studies (18,239 patients) for the primary analysis.
In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I 2 = 30%, 84 studies, n = 18,239).
For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I 2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I 2 = 23%, 12 studies, n = 1,255).
An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time.
Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I 2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I 2 = 0%, 29 studies, n = 5,214).

Conclusions

High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

Level of evidence: Prognostic Level IV . See Instruction for Authors for a complete description of the levels of evidence. Copyright remains with the authors and publisher.

Background

Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

Methods

Results

We identified 84 studies (18,239 patients) for the primary analysis.
In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I 2 = 30%, 84 studies, n = 18,239).
For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I 2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I 2 = 23%, 12 studies, n = 1,255).
An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time.
Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I 2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I 2 = 0%, 29 studies, n = 5,214).

Conclusions

High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

Level of evidence: Prognostic Level IV . See Instruction for Authors for a complete description of the levels of evidence. Copyright remains with the authors and publisher.

Background

Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

Methods

Results

We identified 84 studies (18,239 patients) for the primary analysis.
In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I 2 = 30%, 84 studies, n = 18,239).
For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I 2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I 2 = 23%, 12 studies, n = 1,255).
An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time.
Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I 2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I 2 = 0%, 29 studies, n = 5,214).

Conclusions

High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

Level of evidence: Prognostic Level IV . See Instruction for Authors for a complete description of the levels of evidence. Copyright remains with the authors and publisher.