No difference in mortality between level I and level II trauma centers performing surgical stabilization of rib fracture

Rockne, Wendy Y.; Grigorian, Areg; Christian, Ashton; Nahmias, Jeffry; Lekawa, Michael; Dolich, Matthew; Chin, Theresa L.; Schubl, Sebastian

doi:10.1016/j.amjsurg.2020.09.033

Cited by 10 publications

(25 citation statements)

References 19 publications

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“…Even with improved critical care technology and widespread adoption of adjunctive pain management techniques, outcomes after multiple severe rib fractures have not significantly improved over the past 15 years (30). To date, the practice of rib fixation or surgical stabilization of rib fractures (SSRF) has increased exponentially and is now implemented in most international Trauma Centers (31)(32)(33)(34)(35). Despite increased use, many controversies within the field of SSRF remain.…”

Section: Review Articlementioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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The practice of surgical stabilization of rib fractures (SSRF) for severe chest wall injury has exponentially increased over the last decade due to improved outcomes as compared to nonoperative management. However, regarding in-hospital outcomes, the ideal time from injury to SSRF remains a matter of debate. This review aims to evaluate and summarize currently available literature related to timing of SSRF. Nine studies on the effect of time to SSRF were identified. All were retrospective comparative studies with no detailed information on why patients underwent early or later SSRF. Patients underwent SSRF most often for a flail chest or ≥3 displaced rib fractures. Early SSRF (≤48-72 hours after admission) was associated with shorter hospital and intensive care unit length of stay (HLOS and ICU-LOS, respectively), duration of mechanical ventilation (DMV), and lower rates of pneumonia, and tracheostomy as well as lower hospitalization costs. No difference between early or late SSRF was demonstrated for mortality rate. As compared to nonoperative management, late SSRF (>3 days after admission), was associated with similar or worse in-hospital outcomes. The optimal time to perform SSRF in patients with severe chest wall injury is early (≤48-72 hours after admission) and associated with improved in-hospital outcomes as compared to either late salvage or nonoperative management. These data must however be cautiously interpreted due the retrospective nature of the studies and potential selection and attrition bias. Future research should focus on both factors and pathways that allow patients to undergo early SSRF.

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Section: Review Articlementioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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“…While these did not prove to significantly change outcomes when accounted for in our analysis of HIGH and LOW centers, it contradicted previous notions that Level III centers, which typically have lower rates of CWS surgery, perform simpler CWS procedures on less medically complex patients. Rockne et al 12 found no difference in mortality between Level I and Level II trauma centers that performed SSRF. Our analyses reinforce that the differences in mortality are closely related to hospital volume as compared with trauma center level designation.…”

Section: Discussionmentioning

confidence: 96%

“…11 A relatively more recent evaluation showed no mortality differences between Level I and Level II trauma centers. 12 Centers that frequently perform CWS have adopted protocols for chest wall injury that focus on pulmonary toileting and pain control, as well as implementing institutional policies, which have been associated with improved outcomes. 6,13,14 Previous literature has demonstrated a volume-outcome relationship for several surgical procedures, including herniorrhaphy, cardiac, thoracic, oncological, and bariatric surgery.…”

mentioning

confidence: 99%

Lucky number 13: Association between center-specific chest wall stabilization volumes and patient outcomes

Tillman¹,

Martin²,

Lueckel³

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Chest wall stabilization (CWS) improves outcomes for patients with chest wall injury (CWI). We hypothesized that patients treated at centers with higher annual CWS volumes experience superior outcomes. METHODS:A retrospective study of adults with acute CWI undergoing surgical stabilization of rib or sternal fractures within the 2019 Trauma Quality Improvement Program database, excluding those with 24-hour mortality or any Abbreviated Injury Scale body region of six, was conducted. Hospitals were grouped in quartiles by annual CWS volume. Our primary outcome was a composite of in-hospital mortality, ventilator-associated pneumonia, acute respiratory distress syndrome, sepsis, and unplanned intubation or intensive care unit readmission. Regression was controlled for age, sex, Injury Severity Scale, flail chest, medical comorbidities, and Abbreviated Injury Scale chest. We performed cut-point analysis and compared patient outcomes from high-and low-volume centers. RESULTS:We included 3,207 patients undergoing CWS at 430 hospitals with annual volumes ranging from 1 to 66. There were no differences between groups in age, sex, or Injury Severity Scale. Patients in the highest volume quartile (Q4) experienced significantly lower rates of the primary outcome (Q4, 14%; Q3, 18.4%; Q2, 17.4%; Q1, 22.1%) and significantly shorter hospital and intensive care unit lengths of stay. Q4 versus Q1 had lower adjusted odds of the primary outcome (odds ratio, 0.58; 95% confidence interval, 0.43-0.80). An optimal cut point of 12.5 procedures annually was used to define high-and low-volume centers. Patients treated at high-volume centers experienced significantly lower rates of the primary composite outcome, in-hospital mortality, and deep venous thrombosis with shorter lengths of stay and higher rates of home discharge. CONCLUSION:Center-specific CWS volume is associated with superior in-hospital patient outcomes. These findings support efforts to establish CWI centers of excellence. Further investigation should explore the impact of center-specific volume on patient-reported outcomes including pain and postdischarge quality of life.

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“…Utilization of surgical stabilization of rib fractures (SSRF) has increased significantly over the last two decades [6][7][8]. In patients with a flail chest, SSRF has been associated with a reduced pneumonia rate, and shorter duration of mechanical ventilation and hospital and ICU length of stay (HLOS and ICU LOS) as compared to nonoperative management [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury

Prins

Lieshout

Ali‐Osman

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients. Methods A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern. Results In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11–0.77; p = 0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, − 2.96 days; 95% CI − 5.70 to − 0.23; p = 0.034). Conclusion In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.

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No difference in mortality between level I and level II trauma centers performing surgical stabilization of rib fracture

Cited by 10 publications

References 19 publications

What is the optimal timing to perform surgical stabilization of rib fractures?

What is the optimal timing to perform surgical stabilization of rib fractures?

Lucky number 13: Association between center-specific chest wall stabilization volumes and patient outcomes

Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury

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