Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities
Autor: | Tornetta, Paul, Della Rocca, Gregory J., Morshed, Saam, Jones, Clifford, Heels-Ansdell, Diane, Sprague, Sheila, Petrisor, Brad, Jeray, Kyle J., Del Fabbro, Gina, Bzovsky, Sofia, Bhandari, Mohit, Guyatt, Gordon H., Walter, Stephen D., Schemitsch, Emil H., Anglen, Jeffrey, Bosse, Michael, Liew, Susan, Sancheti, Parag, McKay, Paula, Madden, Kim, Tai, Kerry, Buckingham, Lisa, Duraikannan, Aravin, Tanner, Stephanie L., Snider, Rebecca G., Altman, Douglas, Gandhi, Rajiv, Bischoff, Markus, Ristevski, Bill |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Open fracture Physical Injury - Accidents and Adverse Effects Open Individual risk Surgical Flaps Fractures Open Clinical Research Risk Factors FLOW Investigators Internal medicine Medicine Humans Orthopedics and Sports Medicine Tibia Therapeutic Irrigation business.industry Risk of infection Hazard ratio Baseline data Injuries and accidents Confidence interval Lower Extremity Perioperative care Surgery Patient Safety business Infection Fractures Research Article |
Zdroj: | Paediatrics Publications JAAOS Global Research & Reviews Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, vol 4, iss 12 |
Popis: | Author(s): Tornetta, Paul; Della Rocca, Gregory J; Morshed, Saam; Jones, Clifford; Heels-Ansdell, Diane; Sprague, Sheila; Petrisor, Brad; Jeray, Kyle J; Del Fabbro, Gina; Bzovsky, Sofia; Bhandari, Mohit; FLOW Investigators | Abstract: IntroductionOpen fractures are associated with a high risk of infection. The prevention of infection is the single most important goal, influencing perioperative care of patients with open fractures. Using data from 2,500 participants with open fracture wounds enrolled in the Fluid Lavage of Open Wounds trial, we conducted a multivariable analysis to determine the factors that are associated with infections 12 months postfracture.MethodsEighteen predictor variables were identified for infection a priori from baseline data, fracture characteristics, and surgical data from the Fluid Lavage of Open Wounds trial. Twelve predictor variables were identified for deep infection, which included both surgically and nonoperatively managed infections. We used multivariable Cox proportional hazards regression analyses to identify the factors associated with infection. Irrigation solution and pressure were included as variables in the analysis. The results were reported as adjusted hazard ratios (HRs), 95% confidence intervals (CIs), and associated P values. All tests were two tailed with alpha = 0.05.ResultsFactors associated with any infection were fracture location (tibia: HR 5.13 versus upper extremity, 95% CI 3.28 to 8.02; other lower extremity: HR 3.63 versus upper extremity, 95% CI 2.38 to 5.55; overall P l 0.001), low energy injury (HR 1.64, 95% CI 1.08 to 2.46; P = 0.019), degree of wound contamination (severe: HR 2.12 versus mild, 95% CI 1.35 to 3.32; moderate: HR 1.08 versus mild, 95% CI 0.78 to 1.49; overall P = 0.004), and need for flap coverage (HR 1.82, 95% CI 1.11 to 2.99; P = 0.017).DiscussionThe results of this study provide a better understanding of which factors are associated with a greater risk of infection in open fractures. In addition, it can allow for surgeons to better counsel patients regarding prognosis, helping patients to understand their individual risk of infection. |
Databáze: | OpenAIRE |
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