A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data

Clary J. Foote, Paul Tornetta, Aleksi Reito, Khalid Al-Hourani, Mara Schenker, Michael Bosse, Chad P. Coles, Anthony Bozzo, Andrew Furey, Ross Leighton, GOLIATH Investigators

Research output: Contribution to journalReview ArticleScientificpeer-review

1 Citation (Scopus)

Abstract

BACKGROUND: Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. METHODS: We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then 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: We 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, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, 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, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, 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, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). CONCLUSIONS: High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. LEVEL OF EVIDENCE: Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.

Original languageEnglish
Pages (from-to)265-273
Number of pages9
JournalJOURNAL OF BONE AND JOINT SURGERY: AMERICAN VOLUME
Volume103
Issue number3
DOIs
Publication statusPublished - 3 Feb 2021
Publication typeA2 Review article in a scientific journal

Publication forum classification

  • Publication forum level 3

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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