Delay in Flap Coverage Past 7 Days Increases Complications for Open Tibia Fractures: A Cohort Study of 140 North American Trauma Centers.
JOURNAL OF ORTHOPAEDIC TRAUMA(2019)
摘要
Objectives: To measure time to flap coverage after open tibia fractures and assess whether delays are associated with inpatient complications. Design: Retrospective cohort study. Setting: One forty level I and II trauma centers in Canada and the United States. Patients/ Participants: Adult patients ($ 16 years) undergoing surgery for (1) an open tibia (including ankle) fracture and (2) a soft- tissue flap during their index admission between January 1, 2012, and December 31, 2015, were eligible for inclusion. Exposure: Time from hospital arrival to definitive flap coverage (in days). Main outcome measurements: The primary outcome was a composite of the following complications occurring during the index admission: (1) deep infection, (2) osteomyelitis, and/ or (3) amputation. The primary analysis compared complications between early and delayed coverage groups (# 7 and.7 days, respectively) after matching on propensity scores. We also used logistic regression with time to flap coverage as a continuous variable to examine the impact of the duration of delay on complications. Results: There were 672 patients at 140 centers included. Of these, 412 (61.3%) had delayed coverage (. 7 days). Delayed coverage was associated with a significant increase in complications during the index admission after matching (16.7% vs. 6.2%, P, 0.001, number needed to harm = 10). Each additional week of delay was associated with an approximate 40% increased adjusted risk of complications (adjusted odds ratio 1.44, 95% confidence interval 1.131.82, for each week coverage was delayed, P = 0.003). Conclusion: This is the first multicenter study of flap coverage for tibia fractures in North America. Complications rose significantly when flap coverage was delayed beyond 7 days, consistent with current guideline recommendations. Because the majority of patients did not have coverage within this timeframe, initiatives are required to improve care for patients with these injuries.
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关键词
tibia fractures,open fractures,soft-tissue coverage,fracture fixation,internal,osteosynthesis,complications,epidemiology,retrospective studies,United States
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