A Reevaluation of the Risk of Infection Based on Time to Deb
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Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

Researchers conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection.

Results:
Researchers identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, I2 = 30%, 84 studies, n = 18,239).
--For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, I2 = 23%, 12 studies, n = 1,255).
--An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, I2 = 0%, 29 studies, n = 5,214).

Conclusively, high-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

Source: https://www.jbjs.org/reader.php?id=173844&rsuite_id=2681010&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/Publish Ahead of Print//10.2106/JBJS.20.01103/abstract&topics=ta#info
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