Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes

  • James Dixon (Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus) ;
  • Iain Rankin (Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus) ;
  • Nicholas Diston (University of Aberdeen) ;
  • Joaquim Goffin (Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus) ;
  • Iain Stevenson (Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus)
  • Received : 2023.07.25
  • Accepted : 2023.10.20
  • Published : 2024.03.05
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Abstract

Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

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References

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