The Impact of Time to Surgical Debridement on Infection and Reoperation Rates in Open Upper Limb Fractures.

OBJECTIVE

To examine the association between debridement timing and infection, readmission, and reoperation in open upper-limb fractures.

DESIGN

Retrospective cohort study.

SETTING

Academic Level 1 trauma center.

PATIENT SELECTION CRITERIA: All patients with open upper limb fractures involving the humerus (AO/OTA 1), radius or ulna (AO/OTA 2), scapula (AO/OTA 14), or clavicle (AO/OTA 15) treated at a single academic Level I trauma center between 2014 and 2023 were included. Exclusions were isolated hand injuries, primary amputation, death before surgery, and incomplete records.

OUTCOME MEASURES AND COMPARISONS: Patients were grouped based on time to debridement: ≤24 hours, 24-48 hours, and >48 hours. Multivariable logistic regression models adjusted for American Society of Anesthesiologists grade, Gustilo-Anderson classification, and Injury Severity Score (ISS) evaluated the association between timing and 30-day readmission, 90-day readmission, 1-year reoperation, and infection.

RESULTS

The study included 297 patients [mean age 44.7 years (SD 22.5); 66.9% male]. Baseline demographics were similar across time-to-debridement groups (≤24 hours, n = 154; 24-48 hours, n = 83; >48 hours, n = 60) with no significant differences in age, sex, or ISS (all P > 0.05). Debridement within 24 hours occurred in 154 of 297 patients (51.9%), and 60 of 297 patients (20.2%) experienced delays >48 hours. Outcome rates were 30-day readmission in 18 of 297 patients (6.1%), 90-day readmission in 21 of 297 patients (7.1%), reoperation within 1 year in 44 of 297 patients (14.8%), and postoperative infection in 13 of 297 patients (4.4%). No statistically significant association was observed between debridement timing and 30-day readmission ( P = 0.72), 90-day readmission ( P = 0.83), 1-year reoperation ( P = 0.11), or infection ( P = 0.39).

CONCLUSIONS

Within the studied intervals (≤24, 24-48, and >48 hours), debridement timing up to and including delays >48 hours was not significantly associated with readmission, reoperation within 1 year, or postoperative infection in open upper limb fractures.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.