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 language | English (US) |
|---|---|
| Pages (from-to) | 187-194 |
| Number of pages | 8 |
| Journal | Journal of Trauma and Acute Care Surgery |
| Volume | 80 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2016 |
| Externally published | Yes |
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Keywords
- respiratory failure
- Rib fractures
- surgical stabilization of rib fractures
- tracheostomy
ASJC Scopus subject areas
- Surgery
- Critical Care and Intensive Care Medicine
Cite this
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 journal › Article
}
TY - JOUR
T1 - A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures
AU - Pieracci, Fredric M.
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.
PY - 2016/2/1
Y1 - 2016/2/1
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
KW - tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=84957443095&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84957443095&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000000925
DO - 10.1097/TA.0000000000000925
M3 - Article
C2 - 26595710
AN - SCOPUS:84957443095
VL - 80
SP - 187
EP - 194
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 2
ER -