The effect of delayed timing to surgery on the likelihood of surgical site infection for open metacarpal and phalangeal fractures

PURPOSE: The level of risk for surgical site infection (SSI) and complications associated with delayed timing to surgery (> 24 h) for open metacarpal (OMC) and phalangeal (OPH) fractures has not been outlined. The purpose of this study is to assess the effects of delayed operative intervention on the rate of perioperative SSI following OMC and OPH fractures. METHODS: This is a prognostic study querying a national database from 2015 to 2021 for patients undergoing surgical management of OMCs or OPHs. Delayed surgical intervention for these fractures was defined as greater than 24 h after injury. Primary outcome was 30-day SSI. ANOVA and multivariable logistic regression were used to assess associations with odds ratio (OR) and 95% confidence interval (CI), accounting for age, sex, BMI, and ASA. RESULTS: A total of 1,513 patients underwent surgical intervention [OMC (n = 259), OPH (n = 1,254)]. Of those, 1,330 patients (87.9%) were operatively managed within 24 h (delayed: n = 183, 12.1%). The mean time-to-surgery for delayed patients was 1.3 ± 0.9 days. There was no difference in rates of SSI between those treated within 24 h and the delayed group (OR: 0.80, CI: [0.18-3.43]) or when assessing timing-to-surgery as a continuous variable. There was no difference in rates of any complication, readmission, or reoperation between groups. CONCLUSION: Delayed surgical intervention for selected open metacarpal and phalangeal fractures was not associated with increased rates of 30-day surgical site infection, readmission, reoperation, or overall complications. These findings suggest that carefully selected patients may be safely managed with modest delays to surgery when appropriate antibiotic administration, wound care, and follow-up are ensured. LEVEL OF EVIDENCE: III, Prognostic study.