Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study
Abstract Background Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought t...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-023-03911-5 |
| _version_ | 1827928593476354048 |
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| author | Michael Allen Joshua Gluck Emily Benson |
| author_facet | Michael Allen Joshua Gluck Emily Benson |
| author_sort | Michael Allen |
| collection | DOAJ |
| description | Abstract Background Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections. Methods We performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values. Results Outpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032). Conclusions Outpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients. Level of evidence Level III. |
| first_indexed | 2024-03-13T06:09:55Z |
| format | Article |
| id | doaj.art-e97c1a424b934320ba083df45fe26fac |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-13T06:09:55Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-e97c1a424b934320ba083df45fe26fac2023-06-11T11:20:22ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-06-011811810.1186/s13018-023-03911-5Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort studyMichael Allen0Joshua Gluck1Emily Benson2Community Memorial Health SystemCommunity Memorial Health SystemCommunity Memorial Health SystemAbstract Background Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections. Methods We performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values. Results Outpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032). Conclusions Outpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients. Level of evidence Level III.https://doi.org/10.1186/s13018-023-03911-5InfectionHandUpper extremityCellulitisAntibioticsDiabetes |
| spellingShingle | Michael Allen Joshua Gluck Emily Benson Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study Journal of Orthopaedic Surgery and Research Infection Hand Upper extremity Cellulitis Antibiotics Diabetes |
| title | Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study |
| title_full | Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study |
| title_fullStr | Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study |
| title_full_unstemmed | Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study |
| title_short | Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study |
| title_sort | renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections a retrospective cohort study |
| topic | Infection Hand Upper extremity Cellulitis Antibiotics Diabetes |
| url | https://doi.org/10.1186/s13018-023-03911-5 |
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