Savla R, Kuo YH, Ahmed N. Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures. World J Orthop 2024; 15(6): 539-546 [PMID: 38947263 DOI: 10.5312/wjo.v15.i6.539]
Corresponding Author of This Article
Nasim Ahmed, FACS, Chief Doctor, Full Professor, Department of Surgery, Department of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, 1945 State Rt. 33, Neptune, NJ 07754, United States. nasim.ahmed@hmhn.org
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jun 18, 2024; 15(6): 539-546 Published online Jun 18, 2024. doi: 10.5312/wjo.v15.i6.539
Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures
Riya Savla, Yen-Hong Kuo, Nasim Ahmed
Riya Savla, Department of Surgery and Trauma, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
Yen-Hong Kuo, Department of Medical Sciences, Hackensack Meridian School of medicine, Nutley, NJ 08753, United States
Yen-Hong Kuo, Office of Research Administration, Hackensack Meridian Health Research Institute, Nutley, NJ 077110, United States
Nasim Ahmed, Department of Surgery, Department of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
Nasim Ahmed, Department of Surgery, Department of Trauma and Surgical Critical Care, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
Author contributions: Ahmed N conceptualized the idea, designed the study and accessed the data; Kuo YH performed the statistical analysis; Savla R, Ahmed N and Kuo YH participated in interpreting the data and writing the manuscript.
Institutional review board statement: Due to de-identified national data that is available to researchers for performing the clinical research, Hackensack Meridian Health Institutional Review Board exempted the study from the review.
Informed consent statement: Hackensack Meridian Health Institutional Review Board exempted the study from the review hence waived the informed consent from the study.
Conflict-of-interest statement: All authors declare no conflict of interest, financial or otherwise.
Data sharing statement: Data is available from the American College of Surgeons. Anyone needs the data has to request the data from the ACS.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nasim Ahmed, FACS, Chief Doctor, Full Professor, Department of Surgery, Department of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, 1945 State Rt. 33, Neptune, NJ 07754, United States. nasim.ahmed@hmhn.org
Received: January 26, 2024 Revised: May 7, 2024 Accepted: May 27, 2024 Published online: June 18, 2024 Processing time: 138 Days and 11.5 Hours
Abstract
BACKGROUND
Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection (SSI). Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI. According to the American College of Surgeons (ACS) Best Practice Guidelines, in 2015, irrigation and debridement should be done within 24 hours.
AIM
To identify whether early irrigation and debridement, within 8 hours, vs late, between 8 hours and 24 hours, for pediatric open long bone fractures impacts rate of SSI.
METHODS
Using retrospective data review from the National Trauma Data Bank, Trauma Quality Improvement Project (TQIP) of 2019. TQIP database is own by the ACS and it is the largest database for trauma quality program in the world. Propensity matching analysis was performed for the study.
RESULTS
There were 390 pediatric patients with open long bone fractures who were included in the study. After completing propensity score matching, we had 176 patients in each category, irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours. We found no significant differences between each group for the rate of deep SSI which was 0.6% for patients who received surgical irrigation and debridement within 8 hours and 1.1% for those who received it after 8 hours [adjusted odd ratio (AOR): 0.5, 95%CI: 0.268-30.909, P > 0.99]. For the secondary outcomes studied, in terms of length of hospital stay, patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days, and those who received it after 8 hours stayed for an average of 3 days, with no significant difference found, and there were also no significant differences found between the discharge dispositions of the patients.
CONCLUSION
Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours.
Core Tip: Using the National Trauma Quality Improvement Project of 2019, data from 390 pediatric patients with open long bone fractures showed no significant difference in the rate of surgical site infection when irrigation and debridement was done within 8 hours vs between 8 hours and 24 hours.
