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Does Delay to Theater Lead to Increased Infection Rates in Hand Trauma? A Retrospective Cohort Study

Pavan, Fiona, MBBS*; Albarki, Hashm S., MBBS*; Vu, Joseph, MBBS*; Keating, Cameron, MBBS, FRACS*; Leong, James C., MBBS, FRACS, MS

Plastic and Reconstructive Surgery – Global Open: November 7, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002025
Latest Articles: PDF Only

Background: In an ideal health system, traumatic wounds would be surgically managed within 24 hours; however, resource constraints result in patients with open wounds commonly waiting much longer for surgery. Does this result in increased morbidity? This study compares infection rates over time for patients who received operative management of traumatic hand injuries.

Methods: A retrospective analysis was undertaken of patients admitted between July 2014 and June 2015 who presented within 24 hours of sustaining a hand injury and subsequently underwent operative repair. Patient and injury data were collected from arrival time at emergency departments across 3 Victorian metropolitan hospitals within the same network. Admission and outpatient follow-up of these patients was reviewed for signs of infection and treatment with antibiotics.

Results: Six hundred thirty-eight patients met inclusion criteria, 8 of the 429 patients treated within 24 hours of presentation developed an infection (1.86%) compared with 11 of the 209 patients treated after 24 hours of presentation (5.26%). Using Fisher’s exact analysis, a statistically significant association was identified (P = 0.024). An odds ratio of 2.924 was calculated, with a number needed to harm of 26. When time was analyzed as a continuous variable using logistic regression, there was no statistical significance.

Conclusion: This study shows some evidence that a timing may be important to reduce the rates of infection and raises the possibility that there may be a double peak for infection risk at the 6-hour and 24-hour marks. This gives a basis of potential further study.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Monash Health, Melbourne, Australia

Department of Surgery, Monash University, Monash Medical Centre, Clayton, Australia.

Published online 7 November 2018.

Received for publication July 11, 2018; accepted September 21,2018.

This project abstract was submitted to the hospital within which this research was to be conducted for consideration of the need for review with an ethics committee. It was determined that this project did not raise any ethical concerns and therefore did not require submission to the hospital Health Human Research Ethics Committee. The lead author affirms that this article is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The lead author declares no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Fiona Pavan, MBBS, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.