Surgical Stabilization of Rib Fracture to Mitigate Pulmonary Complication and Mortality: A Systematic Review and Bayesian Meta-Analysis

Choi, Jeff; Gomez, Giselle Isabella; Kaghazchi, Aydin; Borghi, John; Spain, David A.; Forrester, Joseph D.

doi:10.1016/j.jamcollsurg.2020.10.022

Cited by 29 publications

(31 citation statements)

References 57 publications

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“…Over the last years, the indications for SSRF extended. For example, literature on patients with non-flail fracture patterns shows improved short-term outcomes associated with SSRF in these patients with for example multiple severely dislocated rib fractures (40,(55)(56)(57)(58). In addition, traditional contraindications for SSRF, such as traumatic brain injury (TBI), age, or severe pulmonary contusion, are narrowing as SSRF has been shown to be a safe procedure in these patients and has even been correlated with improved outcomes in select patients (59)(60)(61).…”

Section: Ssrfmentioning

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: Ssrfmentioning

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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“…Thirty-nine studies (5 randomized control trials) were analyzed and it was found with 95% probability that SSRF was associated with 2–7 fewer ventilator days, 5–7 fewer days in ICU, 8–12 fewer days hospitalized, 25–80% lower odds of pneumonia, 15–85% lower odds of undergoing tracheostomy, and 35–85% lower odds of mortality compared with non-operative management” (53:212). This accounted for a near 100% probability that SSRF was associated with better outcomes ( 42 ). Another systematic review conducted by Ingoe et al [2019] examined internal surgical fixation compared with any external fixation or non-surgical management.…”

Section: Discussionmentioning

confidence: 99%

A narrative review of traumatic mediastinal injuries and their management: the thoracic surgeon perspective

Williams¹,

Agzarian²

2021

Mediastinum

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Objective Mediastinal injuries are uncommon, rarely encountered and depending on the institution, can be managed by various sub-specialties. The purpose of this narrative review is to present an overview of traumatic mediastinal injuries, their presentation, and management options from the perspective of a thoracic surgeon. Background Although infrequent, traumatic mediastinal injuries can pose significant morbidity and mortality. The infrequency of these injuries limits operative exposure for thoracic surgeons and trainees. A concise overview of common presentations and management options is warranted to further solidify important concepts. Methods A search of the literature was conducted using MEDLINE, PubMed, and Embase for relevant articles pertaining to anatomic injuries of the mediastinum. The presentation of mediastinal injuries along with indications for non-operative versus operative management in cardiac injuries, thoracic esophageal injuries, tracheobronchial injuries, and injuries to the lungs and pleura was conducted and literature summarized. Conclusions In providing this review it is hopeful to enhance knowledge and comfort in recognition and management of these uncommon yet potentially lethal injuries. Early involvement of thoracic surgery is recommended to ensure effective and efficient treatment.

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“…Strategies to optimize pain control exist along a spectrum-from multimodal oral and intravenous medications, neuraxial blockade, to surgical stabilization of rib fractures (SSRF). For patients with flail chest, a flail segment, or three or more displaced rib fractures, surgical stabilization can offer decreased time on a ventilator, shorter intensive care unit and hospital stays, decreased risk of pneumonia or tracheostomy, faster return to work, decreased pain, lower mortality, lower inpatient charges and is cost-effective therapy for health insurance payors and healthcare systems (1)(2)(3)(4)(5). However, SSRF is underutilized and may not be available at all healthcare facilities (6,7).…”

Section: Introductionmentioning

confidence: 99%