A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures

Fredric M. Pieracci, Yihan Lin, Maria Rodil, Madelyne Synder, Benoit Herbert, Dong Kha Tran, Robert T. Stoval, Jeffrey L. Johnson, Walter L. Biffl, Carlton C. Barnett, Clay Cothren-Burlew, Charles Fox, Gregory Jurkovich, Ernest E. Moore

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. Methods We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30% or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Results Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p < 0.01) and a significantly lower incidence of intracranial hemorrhage (5.7% vs. 28.6%, respectively, p = 0.01). After controlling for these differences, the operative group had a significantly lower likelihood of both respiratory failure (odds ratio, 0.24; 95% confidence interval, 0.06-0.93; p = 0.03) and tracheostomy (odds ratio, 0.18; 95% confidence interval, 0.04-0.78; p = 0.03). Duration of ventilation was significantly lower in the operative group (p < 0.01). The median daily spirometry value was 250 mL higher in the operative group (p = 0.04). Narcotic requirements were comparable between groups. There were no mortalities. Conclusion In this evaluation, SSRF as compared with the best medical management improved acute outcomes among a group of critically ill trauma patients with a variety of severe fracture patterns. Level of Evidence Therapeutic study, level II.

Original languageEnglish (US)
Pages (from-to)187-194
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Rib Fractures
Tracheostomy
Flail Chest
Respiratory Insufficiency
Narcotics
Ribs
Critical Illness
Wounds and Injuries
Odds Ratio
Confidence Intervals
Mortality
Intracranial Hemorrhages
Spirometry
Mechanical Ventilators
Operative Time
Sample Size
Ventilation
Motivation
Length of Stay
Pneumonia

Keywords

  • respiratory failure
  • Rib fractures
  • surgical stabilization of rib fractures
  • tracheostomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Pieracci, F. M., Lin, Y., Rodil, M., Synder, M., Herbert, B., Tran, D. K., ... Moore, E. E. (2016). A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. Journal of Trauma and Acute Care Surgery, 80(2), 187-194. https://doi.org/10.1097/TA.0000000000000925

A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. / Pieracci, Fredric M.; Lin, Yihan; Rodil, Maria; Synder, Madelyne; Herbert, Benoit; Tran, Dong Kha; Stoval, Robert T.; Johnson, Jeffrey L.; Biffl, Walter L.; Barnett, Carlton C.; Cothren-Burlew, Clay; Fox, Charles; Jurkovich, Gregory; Moore, Ernest E.

In: Journal of Trauma and Acute Care Surgery, Vol. 80, No. 2, 01.02.2016, p. 187-194.

Research output: Contribution to journalArticle

Pieracci, FM, Lin, Y, Rodil, M, Synder, M, Herbert, B, Tran, DK, Stoval, RT, Johnson, JL, Biffl, WL, Barnett, CC, Cothren-Burlew, C, Fox, C, Jurkovich, G & Moore, EE 2016, 'A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures', Journal of Trauma and Acute Care Surgery, vol. 80, no. 2, pp. 187-194. https://doi.org/10.1097/TA.0000000000000925
Pieracci, Fredric M. ; Lin, Yihan ; Rodil, Maria ; Synder, Madelyne ; Herbert, Benoit ; Tran, Dong Kha ; Stoval, Robert T. ; Johnson, Jeffrey L. ; Biffl, Walter L. ; Barnett, Carlton C. ; Cothren-Burlew, Clay ; Fox, Charles ; Jurkovich, Gregory ; Moore, Ernest E. / A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 80, No. 2. pp. 187-194.
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abstract = "Background Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. Methods We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30{\%} or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Results Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p < 0.01) and a significantly lower incidence of intracranial hemorrhage (5.7{\%} vs. 28.6{\%}, respectively, p = 0.01). After controlling for these differences, the operative group had a significantly lower likelihood of both respiratory failure (odds ratio, 0.24; 95{\%} confidence interval, 0.06-0.93; p = 0.03) and tracheostomy (odds ratio, 0.18; 95{\%} confidence interval, 0.04-0.78; p = 0.03). Duration of ventilation was significantly lower in the operative group (p < 0.01). The median daily spirometry value was 250 mL higher in the operative group (p = 0.04). Narcotic requirements were comparable between groups. There were no mortalities. Conclusion In this evaluation, SSRF as compared with the best medical management improved acute outcomes among a group of critically ill trauma patients with a variety of severe fracture patterns. Level of Evidence Therapeutic study, level II.",
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AU - Lin, Yihan

AU - Rodil, Maria

AU - Synder, Madelyne

AU - Herbert, Benoit

AU - Tran, Dong Kha

AU - Stoval, Robert T.

AU - Johnson, Jeffrey L.

AU - Biffl, Walter L.

AU - Barnett, Carlton C.

AU - Cothren-Burlew, Clay

AU - Fox, Charles

AU - Jurkovich, Gregory

AU - Moore, Ernest E.

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N2 - Background Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. Methods We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30% or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Results Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p < 0.01) and a significantly lower incidence of intracranial hemorrhage (5.7% vs. 28.6%, respectively, p = 0.01). After controlling for these differences, the operative group had a significantly lower likelihood of both respiratory failure (odds ratio, 0.24; 95% confidence interval, 0.06-0.93; p = 0.03) and tracheostomy (odds ratio, 0.18; 95% confidence interval, 0.04-0.78; p = 0.03). Duration of ventilation was significantly lower in the operative group (p < 0.01). The median daily spirometry value was 250 mL higher in the operative group (p = 0.04). Narcotic requirements were comparable between groups. There were no mortalities. Conclusion In this evaluation, SSRF as compared with the best medical management improved acute outcomes among a group of critically ill trauma patients with a variety of severe fracture patterns. Level of Evidence Therapeutic study, level II.

AB - Background Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. Methods We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30% or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Results Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p < 0.01) and a significantly lower incidence of intracranial hemorrhage (5.7% vs. 28.6%, respectively, p = 0.01). After controlling for these differences, the operative group had a significantly lower likelihood of both respiratory failure (odds ratio, 0.24; 95% confidence interval, 0.06-0.93; p = 0.03) and tracheostomy (odds ratio, 0.18; 95% confidence interval, 0.04-0.78; p = 0.03). Duration of ventilation was significantly lower in the operative group (p < 0.01). The median daily spirometry value was 250 mL higher in the operative group (p = 0.04). Narcotic requirements were comparable between groups. There were no mortalities. Conclusion In this evaluation, SSRF as compared with the best medical management improved acute outcomes among a group of critically ill trauma patients with a variety of severe fracture patterns. Level of Evidence Therapeutic study, level II.

KW - respiratory failure

KW - Rib fractures

KW - surgical stabilization of rib fractures

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