Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Abstract

Purpose Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with nonoperative treatment, with special focus on the impact of surgical complications. Methods A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients' injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients' medical files. Crude and matched-pairs analyses were performed in SPSS. Results Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. Seven surgery-related complications occurred, of which three required invasive solutions. Conclusions Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

“…Twenty-five studies ( n = 4485) reported on the incidence of pneumonia (Online Appendix 4) [16–19, 22, 24–26, 28, 30–33, 37–39, 41–44, 47, 50, 51]. Rib fixation resulted in a significant reduction of pneumonia compared to nonoperative treatment with a risk ratio of 0.59 (95% CI 0.42, 0.83, p = 0.002, I 2 = 79%) (Online Appendix 9).…”

Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

“…Therefore, the appropriate management of complex CWI may be an important step to reduce unnecessary readmission. In recent years, some studies have reported that SSRF in complex CWI provides short-term benefits that are superior to conservative treatment [33][34][35][36]. Furthermore, early SSRF may provide several advantages over late SSRF [37][38][39].…”

Thoracic trauma: a descriptive review of 4168 consecutive cases in East China

“…Surgical procedures were mainly aimed to stabilize the thorax wall and maintain effective air exchange. [9–13] To this end, tube thoracostomy was the most common procedure performed in these thoracic injured patients. It was shown that operative intervention was not necessary in more than 3/4 of the thoracic injuries.…”