背景:由于手术部位感染(SSI)的风险,开放性长骨骨折是儿科患者的主要关注点。早期研究建议在6小时-8小时内对开放性骨折进行冲洗和清创,以预防SSI。根据美国外科医生学会(ACS)最佳实践指南,2015年,灌溉和清创应在24小时内完成。
目的:为了确定早期冲洗和清创是否,8小时内,vs晚了,在8小时到24小时之间,对于小儿开放性长骨骨折影响SSI的发生率。
方法:使用国家创伤数据库的回顾性数据回顾,2019年创伤质量改善项目(TQIP)。TQIP数据库由ACS拥有,是世界上最大的创伤质量计划数据库。对该研究进行倾向匹配分析。
结果:有390名患有开放性长骨骨折的儿科患者被纳入研究。完成倾向得分匹配后,我们每个类别都有176名患者,在8小时内进行灌溉和清创,在8小时至24小时之间进行灌溉和清创。我们发现各组之间的深层SSI发生率没有显着差异,在8小时内接受手术冲洗和清创的患者为0.6%,在8小时后接受手术冲洗和清创的患者为1.1%[调整后的奇数比(AOR):0.5,95CI:0.268-30.909,P>0.99]。对于研究的次要结果,就住院时间而言,在8小时内接受冲洗和清创的患者平均停留3.5天,那些在8小时后收到它的人平均停留了3天,没有发现显著差异,患者的出院倾向之间也没有显着差异。
结论:我们的研究结果支持ACS治疗开放性长骨骨折的建议:在24小时内完成手术冲洗和清创。
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.
OBJECTIVE: 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.
CONCLUSIONS: Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours.