Risk factors of revision surgeries among primary hand infections presenting in emergency services
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Abstract
OBJECTIVE: To determine the risk factors involved in revision surgeries in primary hand infections presenting in emergency department in Civil Hospital Karachi.
METHODS: This prospective observational study was conducted in Department of Plastics and Reconstructive Surgery, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan during August, 2021 to April, 2022. Patients of any gender of age 12 years and above, requiring surgical management of primary hand infections were included in this study. The data was recorded in a pre-designed proforma.
RESULTS: Out of 270 patients, 174 (64.4%) were males. Median age of patients was 47 (IQR= 35-55) years. Trauma (n=132, 48.9%), boiling water (n=38, 14.1%), idiopathic (n=34, 12.6%) & foreign bite (n=25, 9.3%) were common mechanisms of injuries. Common infection types were felon (n=80; 29.6%), superficial abscess (n=81; 30%) and deep abscess (n=66; 24.4%). Culture growth was positive in 226 (83.7%) cases. Multiple culture growth (>1 culture) was seen in 15 (5.6%) patients. Methicillin-sensitive Staphylococcus auerus (n=85; 37.8%) and Methicillin-resistant Staphylococcus aureus (n=75; 33.3%) were most common pathogens isolated. Forty-nine (18.1%) patients underwent reoperation. Chronic kidney disease (CKD) (aOR 10.95; 95% CI: 1.40-85.41), Diabetes Mellitus (aOR 3.33; 95% CI: 1-11.02), positive culture-growth (OR 0.18; 95% CI: 0.04-0.78), increasing total leukocyte count (TLC) [aOR 1.60; 95% CI: 1.27-2.01] and erythrocyte sedimentation rate (ESR) (aOR 1.05; 95% CI: 1.02-1.09) were identified as independent predictor for reoperation.
CONCLUSION: A considerable number of patients underwent reoperation. CKD, Diabetes Mellitus, increasing TLC and ESR at the time of presentation were significant predictors of reoperation.
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