Delayed Surgical Debridement in Open Fractures Amidst The COVID–19 Pandemic and Infection Rates : A Retrospective Cohort Study
Keywords:
COVID-19, open fractures, infection rates, complications, timingAbstract
Objective: The purposes of this study were to determine the association between delayed time to surgical debridement and an infection rate in open fractures during the COVID–19 pandemic, to evaluate the association between other clinical determinants and complications, and to compare the incidence of open fractures during lockdown period with the normal situation.
Methods: A retrospective cohort study of 210 patients with open fractures between December 21, 2020 and March 31, 2021 was conducted. The data collection included patient demographics, fracture sites, mechanism of injuries, Gustilo and Anderson grading, the RT-PCR for COVID–19 screening, time to surgery, operative time, duration of intravenous antibiotics, the length of hospital stay, and complications.
Results: The mean age of patients was 35.7+14.1 years. The preoperative screening for COVID-19 using RT-PCR test were negative in all patients. The mean time to surgery was 13.2+7.9 hours. The average surgical time was 26.5+21.3 minutes. The postoperative infections were found in 16 patients (7.6%). The increase in infection rate showed no statistically significant difference compared with the same period in 2019 and 2020 (n=11, 5.5% and n=15, 6.5%; p=0.693). Total complications accounting for 16.2% (n=34) included surgical site infection (n=16, 7.6%), re-surgery (n=8, 3.8%), limb amputation (n=4, 1.9%), soft tissue defect needed flap coverage (n=5, 2.4%) and re-admission within 30 days (n=1, 0.5%). The multivariate logistic regression analysis demonstrated that the strongest factor for both infections and total complications was Grade 3 of Gustilo and Anderson (OR 3.53; 95%CI, 1.23–10.12 and OR 6.46; 95%CI, 2.88–14.49 respectively). Meanwhile a delayed time to surgery was not a potential predictive factor for infections and total complications (OR 1.70; 95%CI, 0.56–5.17 and OR 1.90; 95%CI, 0.84–4.31).
Conclusion: Despite a delayed surgical debridement in open fractures during the COVID-19 pandemic, no statistically significant increase in infection rate was observed. The strongest predictor for the development of infections and other complications was a high grade of injury (Grade 3 of Gustilo and Anderson classification)
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
