Identifying Predictors of Time to Soft Tissue Reconstruction Following Open Tibia Fractures

INTRODUCTION: Controversy remains regarding the optimal timing of soft tissue coverage following severe lower extremity trauma. This study identifies nationwide practice patterns and factors associated with discrepancies in time to first flap surgery following open tibia fractures. METHODS: A retrospective analysis was performed on the National Trauma Databank from 2008-2015 to identify patients who presented with an open tibia fracture and underwent subsequent flap reconstruction. A lasso algorithm was performed, revealing those factors most significantly associated with differences in time to flap surgery from hospitalization. RESULTS: A total of 3,297 patients were included in the analysis. Mean and median times to first flap surgery were 230.1 hours (SD; 246.7 hours), and 169.1 hours, respectively. Older age, a non-white race, treatment in the South, and a non-private insurance status were all independently associated with an increased time to flap surgery. In addition, more surgical debridements, a higher injury severity and/or abbreviated injury score, and a nerve, vascular, and/or crush injury were independent predictors of an increased time to flap surgery. CONCLUSION: Most patients who present with open tibia fractures requiring soft tissue coverage undergo flap reconstruction after the historical 72-hour window. Specific sociodemographic and clinical factors were independently predictive of an increased time to flap surgery. These findings suggest that not all patients in the United States are receiving the same level of care in lower extremity trauma reconstruction, emphasizing the need to develop more explicit national standards. * These authors contributed equally to this work Financial Disclosure Statement: None of the authors have a financial disclosure Corresponding Author Contact Information: Scott T. Hollenbeck, MD, Associate Professor, Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, NC 27710, USA. Phone: (919) 681-5079 | Fax: (919) 681-2670, Email: scott.hollenbeck@duke.edu ©2018American Society of Plastic Surgeons

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