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Risk factors for reoperation in primary hand infections: a multivariate analysis

  • A. Arsalan-WernerEmail author
  • P. Grisar
  • M. Sauerbier
Handsurgery

Abstract

Introduction

Severe hand infection might cause severe morbidity including stiffness, contracture and possibly amputation. The purpose of this study was to analyse the current epidemiology of adult acute hand infections in a European Hand Surgery Centre and to identify risk factors for secondary surgery.

Materials and methods

We retrospectively analyzed a cohort of 369 consecutive patients with primary infection of the hand that were admitted to our department and required operative treatment. The following variables were recorded: demographics, medical history, cause and location of infection, laboratory values, cultured microorganisms and reoperation rate. Univariate logistical regression was used to identify variables associated with reoperation and backward selection was applied to identify the final multiple variable model.

Results

The mean age at the time of operation was 50.5 years (SD 16.1, range 19–91) and 65.6% of patients were male. Sharp cuts or lacerations were the most common cause (29.0%) for hand infections. 81 different species were cultivated and in 47 patients (12.7%), the cultures were positive for more than one organism. Staphylococcus aureus was the most common cultured organism (19.5%). There were relatively few cases of methicillin-resistant Staphylococcus aureus (2.2%). 80 patients (21.7%) needed more than one operation. We identified three risk factors for reoperation in a multivariate analysis: an elevated value of C-reactive protein at the time of admission, involvement of multiple sites and bacterial growth in culture.

Conclusion

The rate of infections with MRSA in this European cohort was lower compared to reports from the USA. Thus, hand surgeons should choose their empiric antibiotic therapy depending on their patient population. The knowledge of risk factors for severe hand infections might help surgeons to identify patients at risk for additional surgery early.

Keywords

Hand infection Incidence Methicillin-resistant Staphylococcus aureus Reoperation 

Notes

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors have no conflicting interests.

Ethical approval

The ethics committee of the regional State chamber of Medicine approved the study (FF 2/2018).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department for Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG-Trauma Center Frankfurt am MainAcademic Hospital of the Johann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Trauma and Orthopedic Surgery, BG-Trauma Center Frankfurt am MainAcademic Hospital of the Johann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany

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