Surgical Site Infection after Surgical Stabilization of Rib Fractures: Rare but Morbid

Abstract

Background: Although surgical stabilization for rib fractures (SSRF) has been adopted widely over the past decade, little information is available regarding the prevalence and outcomes of post-operative surgical site infection (SSI). We hypothesized that SSI after SSRF is uncommon but morbid. Patients and Methods: Patients undergoing SSRF at a level 1 trauma center from 2010-2020 were reviewed. The primary outcome was the prevalence of SSI, documented by clinical examination, radiography, systemic markers of infection, and microbiology. Results: Of 228 patients undergoing SSRF, 167 (73.2%) were male, the median age was 53 years (P 25 -P 75 ; 41-63 years), injury severity score (ISS) was 19 (P 25 -P 75, 13-26), with a median of eight fractured ribs (P 25 -P 75, 6-11). All stabilization plates were titanium. SSRF was typically performed on post-injury day one (P 25 -P 75, 0-2 days) after trauma. All patients received antibiotic agents within 30 minutes of incision, and a median of four ribs (P 25 -P 75, 3-6) were repaired. Four (1.8%) patients developed an SSI and all underwent implant removal. Two patients required implant removal within 30 days (on post-operative day seven and 17) and two for chronic infection at seven and 17 months after SSRF. The causative organism was methicillin-sensitive Staphylococcus aureus (MSSA) bacteria in all patients. After implant removal, three patients received intravenous and oral antibiotic agents, ranging from two to six weeks, without recurrent infection. No patient required additional SSRF. Conclusions: Surgical site infection after SSRF is rare but morbid and can become symptomatic within one week to 17 months. Implant removal results in complete recovery.

Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: An international, retrospective matched case-control study

“…Complications related to SSRF were relatively low, with a surgical site infection in 5% of patients and similar rates of thoracic bleeding and additional CPR settings after admission between treatment groups. The surgical site infection rate is higher than the approximately 2% after SSRF for posttraumatic rib fractures 31,32 . The relatively low sample size as compared with previous posttraumatic rib literature could explain this discrepancy or because the stratification for superficial or deep infection was not made in the current study.…”

“…The surgical site infection rate is higher than the approximately 2% after SSRF for posttraumatic rib fractures. 31,32 The relatively low sample size as compared with previous posttraumatic rib literature could explain this discrepancy or because the stratification for superficial or deep infection was not made in the current study. In the early SSRF subgroup as compared with their matched controls, thoracic bleeding more often occurred, indicating that, when early SSRF is considered, anticoagulant use or temporary stop should be weighed carefully.…”

Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

“…Despite the low hardware infection rate demonstrated in this study (and the literature), the treatment has historically been systemic antibiotics and surgery requiring hardware removal [ 13 , 24 - 26 ]. Often the wound care can be tedious for these infections, requiring additional bone and soft tissue debridement, and the rib fractures often demonstrate a non-union at the time of hardware explanation, which was the case in our study [ 13 , 24 , 25 ]. A recent study by Junker et al utilized a management strategy becoming more common in the field of orthopedic infected joints: antibiotic-impregnated cement beads [ 24 , 27 , 28 ].…”

“…Junker et al reported an infection rate of 3.5% among 285 patients who underwent SSRF [ 24 ]. Furthermore, a study by Prins et al, analyzing 228 patients over a 10-year period who underwent SSRF, showed a hardware infection rate of 1.8% in which all patients required hardware removal [ 25 ]. Comparatively, our study demonstrated an even lower risk of hardware infection at 0.4% with over double the number of patients compared to the Prins et al study.…”

Early Surgical Stabilization of Rib Fractures is Feasible in Patients With Non-Urgent Operative Pelvic Injuries

“…[4][5][6] The indications for SSRF have broadened to include patients with flail chest, multiple severely displaced rib fractures, and failure of non-operative management leading to an exponential rise in the utilization of SSRF. [7][8][9][10][11][12] The timing of SSRF has also been investigated with studies showing that early SSRF results in shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and fewer ventilator days. 10,[13][14][15][16][17][18][19][20] Some studies have also demonstrated a decreased rate of pneumonia, tracheostomy, and lower hospital costs in patients undergoing early SSRF.…”