Predicting Amputation Among Six-Hundred Community-Acquired Hand Infections—A Surgical and Infectiology Cohort

Background/Objectives: Acute hand infections are common in emergency surgery. Amputation is the ultimate fate when antibiotics and the prior surgical repair fail. Unsurprisingly, clinician tend to exaggerate with the evidence-based indications of antibiotic treatment and flaps. Methods: We investigate 166 risk association of community-acquired (traumatic) hand infection with amputation, overall treatment failure and the necessity for a secondary flap, using a specifically-designed retrospective single-center cohort between March 2018 October 2020 in Germany. Results: Among 600 adult patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required an amputation. Multivariate Cox regression analysis identified only inherent risks associated with "amputation": male sex (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.28-7.69), advanced age (OR 1.03, 95% CI 1.01-1.04), diabetes (OR 2.40, 95% CI 1.15-5.01, whereas all interventional variables such as early flapping or antibiotic-related parameters (early empiric antibiotic use, total duration of antibiotics and of tits parenteral part, choice of agents,) could not alter outcomes. Conclusions: In severe (traumatic) hand infections among adult German patients, the outcomes are determined by the extent of trauma and underlying co-morbidities. The outcomes do not seem to be effectively reduced by exaggerations of the indication of surgical or antibiotic interventions.