เปรียบเทียบอัตราและลักษณะการติดเชื้อในผู้ป่วยกระดูกยาวหักแบบเปิด จำแนกตามระยะเวลารอการผ่าตัดหลังรับไว้รักษาในโรงพยาบาล

Teparit  Wongsarat

Authors

Teparit Wongsarat Somdej Phra Sangharach Hospital No. 17 Suphanburi Province

Keywords:

Open-fracture Infection Surgical-waiting-time Gustilo-Anderson classification Infection surveillance

Abstract

Objective: The study’s purpose was to compare infection rates in patients with open long bone fractures according to debridement waiting time after hospital admission, compare infection severity with surgical waiting time, analyze the relationship between surgical waiting time and infection onset timing, and analyze the relationship between Gustilo-Anderson classification grade and infection occurrence.

Methods: This retrospective comparative study included 158 patients from January 2018 to December 2024. A six-part open fracture data recording form was validated by three experts (IOC ≥ 0.50). Infection criteria followed CDC Guidelines for Prevention of Surgical Site Infection (2017) and Fracture-Related Infection Consensus Group criteria (2018). Data were analyzed using descriptive and inferential statistics including chi-square test and Fisher's exact test.

Results: Overall infection rate was 18.4%. The group operated within 6 hours had an infection rate of 19.7%, the 6–24 hours group had 12.7%, and the group beyond 24 hours had 29.2%. Infection severity differed significantly according to surgical waiting time (p < .05), though no pairwise comparison reached significance, with the group operated within 6 hours showing the highest proportion of deep SSI (71.4%), while the group operated after 24 hours showed the highest proportion of superficial SSI (71.4%). Gustilo-Anderson classification was significantly associated with infection rates (p < .001), with infection rates increasing progressively by injury severity.

Conclusion: Surgical urgency should be prioritized based on Gustilo-Anderson classification severity. Surgical planning can be conducted within 24 hours without strict adherence to the "6-hour rule." Medical staff should be trained to accurately assess Gustilo-Anderson severity grading, and quality initial wound management should be emphasized.

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