TY - JOUR
T1 - Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities
AU - the FLOW Investigators
AU - Tornetta, Paul
AU - Della Rocca, Gregory J.
AU - Morshed, Saam
AU - Jones, Clifford
AU - Heels-Ansdell, Diane
AU - Sprague, Sheila
AU - Petrisor, Brad
AU - Jeray, Kyle J.
AU - Del Fabbro, Gina
AU - Bzovsky, Sofia
AU - Bhandari, Mohit
AU - Guyatt, Gordon H.
AU - Walter, Stephen D.
AU - Schemitsch, Emil H.
AU - Anglen, Jeffrey
AU - Bosse, Michael
AU - Liew, Susan
AU - Sancheti, Parag
AU - McKay, Paula
AU - Madden, Kim
AU - Tai, Kerry
AU - Buckingham, Lisa
AU - Duraikannan, Aravin
AU - Tanner, Stephanie L.
AU - Snider, Rebecca G.
AU - Altman, Douglas
AU - Gandhi, Rajiv
AU - Bischoff, Markus
AU - Ristevski, Bill
AU - Rajaratnam, Krishan
AU - Williams, Dale
AU - Denkers, Matthew
AU - Bednar, Drew
AU - Sadler, John
AU - Kwok, Desmond
AU - Drew, Brian
AU - Wong, Ivan
AU - Hall, Jeremy A.
AU - McKee, Michael D.
AU - Ahn, Henry
AU - Whelan, Daniel
AU - Waddell, James
AU - Daniels, Timothy
AU - Bogoch, Earl
AU - Nauth, Aaron
AU - Vicente, Milena R.
AU - Hidy, Jennifer T.
AU - Schmidt, Andrew
AU - Yoon, Patrick
AU - Varecka, Thomas
N1 - Publisher Copyright:
Copyright © 2020 The Authors
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Introduction: Open 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. Methods: Eighteen 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. Results: Factors 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< 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). Discussion: The 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.
AB - Introduction: Open 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. Methods: Eighteen 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. Results: Factors 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< 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). Discussion: The 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.
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U2 - 10.5435/JAAOSGlobal-D-20-00188
DO - 10.5435/JAAOSGlobal-D-20-00188
M3 - Article
C2 - 33986214
AN - SCOPUS:85105903794
SN - 2474-7661
VL - 4
JO - Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
JF - Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
IS - 12
M1 - e20.00188
ER -