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


JournalUniversity of groningen
Article typeJournal research article – Systematic review
Publication date – Feb – 2021
Authors – Clary J. Foot, Paul Tornetta III, Aleksi Reito, Khalid Al-Hourani, Mara Schenker, Michael Bosse, Chad P. Coles, Anthony Bozzo, Andrew Furey, Ross Leighton, and the GOLIATH Investigators*
KeywordsLMIC, open fractures, trauma
Open access – Yes
SpecialityTrauma and orthopaedic surgery
World region Global

Language – English
Submitted to the One Surgery Index on February 4, 2023 at 11:06 pm
Abstract:

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, I2 = 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, I2 = 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, I2 = 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, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214).

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

OSI Number – 21853

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