THE IMPACT OF TIME TO SURGICAL DEBRIDMENT ON INFECTION & REOPERATION RATES IN OPEN UPPER LIMB FRACTURES.

Abstract

To examine the association between debridement timing and infection, readmission, and reoperation in open upper-limb fractures. Design: Retrospective cohort study. Academic Level 1 Trauma Center. 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. Patients were grouped based on time to debridement: ≤24 hours, 24-48 hours, and >48 hours. Multivariable logistic regression models adjusted for ASA grade, Gustilo-Anderson classification, and ISS evaluated the association between timing and 30-day readmission, 90-day readmission, one-year reoperation, and infection. 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 h, n=154; 24-48 h, n=83; >48 h, n=60) with no significant differences in age, sex, or ISS (all p>0.05). Debridement within 24 hours occurred in 154/297 (51.9%), and 60/297 (20.2%) experienced delays >48 hours. Outcome rates were: 30-day readmission 18/297 (6.1%), 90-day readmission 21/297 (7.1%), reoperation within one year 44/297 (14.8%), and postoperative infection 13/297 (4.4%). No statistically significant association was observed between debridement timing and 30-day readmission (p=0.72), 90-day readmission (p=0.83), one-year reoperation (p=0.11), or infection (p=0.39). 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 one year, or postoperative infection in open upper limb fractures. Therapeutic Level III - Retrospective cohort study.