Artikel
Predicting Factors for recurrence in Septic Flexor Tenosynovitis of the Hand: A retrospective study
Suche in Medline nach
Autoren
-
Camillo Theo Müller
- CHUV, centre de la main, Lausanne, Switzerland
-
Paolo Erba
- Inselspital Bern, Bern, Switzerland
-
Jean-Yves Beaulieu
- HUG, Genève, Switzerland
-
Ilker Uckay
- HUG, Genève, Switzerland
| Veröffentlicht: | 20. September 2016 |
|---|
Gliederung
Text
Objectives: Septic flexor tenosynovitis of the hand is a frequent emergency. This diseases is associated with multiple surgeries, prolonged antibiotic therapy and longsome ambulatory treatment. Factors associated with adverse outcome are little known. We conducted this study to identify factors associated with the need of subsequent surgery for a secondary aggravation of the clinical signs of infection.
Methods: In a retrospective single-center study we analyzed all adult patient, consulting our emergency department from 2007 to 2010, with a septic flexor tenosynovitis. We compared patients having a single surgical intervention to those having multiple interventions. Multivariate analysis adjusted the considerable case-mix.
Results: A total of 126 adult patients (58 females; median age 46y, 9 immune suppressed) were included; all with community-acquired septic tenosynovitis (the dominant hand in 93%;. pollux 39%, index 33%, thumb 20%, annular 17% and the digiti minimi 12%). Thirty-four (27%) had a subcutaneous abscess; 8 (6%) were febrile. All underwent at least one surgical debridement with concomitant antibiotic therapy for a median of 20 days (range, 7-82d). Eighteen patients underwent more than one surgical intervention (median number of 1.13 interventions, range 1-5). All episodes were cured after a median follow-up of 27 months.
The multivariate analysis showed two significant associations with the outcome parameter "subsequent surgical intervention". These were "presence of an abscess" (odds ratio 4.6, 95% confidence interval 1.50-14.0) and "duration of antibiotic administration" (odds ratio 1.17; 95%CI 1.05-1.19). Of note, the goodness-of-fit test was insignificant (p=0.54) and the Receiver Operating Curve (ROC) value equaled 0.84; highlighting a more than acceptable accuracy of our final model.
Conclusions: Regarding septic flexor tendon synovitis: an abscess at the initial clinical evaluation is a highly significant and independent parameter, predicting the need of subsequent surgery.
