Surgical stabilization of rib fractures is associated with improved survival but increased acute respiratory distress syndrome

Abstract

Background How the surgical stabilization of rib fractures after trauma affects the development of acute respiratory distress syndrome and impacts survival has yet to be determined in a large database. We hypothesized that surgical stabilization of rib fractures would not decrease the incidence of acute respiratory distress syndrome. Methods The National Trauma Data Bank was queried for all traumatic rib fractures in 2016. Patients were divided into groups with single rib fractures, multiple rib fractures, and flail chest. Nonoperative therapy was compared with stabilization of rib fractures of 1 to 2 ribs or 3+ ribs. Results There were 114,972 total patients with rib fractures meeting inclusion criteria, with 5,106 (4.4%) having flail chest, 24,726 (21.5%) having single rib fractures, and 85,140 (74.1%) having multiple rib fractures. Those with flail chest (15.9%) were most likely to get rib plating in comparison to multiple rib fractures (0.9%) and single rib fractures (0.2%); P < .001. On logistic regression, surgical stabilization of rib fractures 1 to 2 ribs (odds ratio: 0.17, 95% confidence interval: 0.10–0.28) or 3+ ribs (odds ratio: 0.17, 95% confidence interval: 0.11–0.28), with nonoperative therapy as the reference was associated with survival. Variables associated with mortality included increasing age, male sex, increasing injury severity score, decreased Glasgow coma scale, requirement of transfusions, and hypotension on admission. Surgical stabilization of rib fractures 3+ ribs (odds ratio: 2.30, 95% confidence interval: 1.58–3.37) was associated with acute respiratory distress syndrome but not 1 to 2 ribs (odd ratio: 1.55, 95% confidence interval: 0.97–2.48). On logistic regression of only patients with flail chest, stabilization of rib fractures was associated with decreased mortality but not increased risk of acute respiratory distress syndrome. Conclusion The increased risk of acute respiratory distress syndrome should be considered in the preoperative assessment for stabilization of rib fractures.

Rib Plating as an Effective Approach to Managing Traumatic Rib Injuries: A Review of the Literature

“…In a study conducted by Taghavi et al, 114,972 patients with rib fractures were classified as having FC (n = 5,106), multiple rib fractures (MRF) (n = 85,140), or a single rib fracture (SRF) (n = 24,726) [ 19 ]. The median age (in years) of patients in each group was 57.0, 56.0, and 50.0, respectively.…”

“…The median age (in years) of patients in each group was 57.0, 56.0, and 50.0, respectively. Females comprised 24.9% of participants with FC, 32.3% of those with MRF, and 31.2% of those with SRF [ 19 ]. In total, 98.6% of study participants were treated conservatively while 1.4% were treated surgically.…”

“…In total, 98.6% of study participants were treated conservatively while 1.4% were treated surgically. Amongst in-hospital patients, those who underwent surgical stabilization were found to require longer HLOS (5.0 vs 13.0 days; p < 0.001), ICU LOS (4.0 vs 8.0 days; p < 0.001), mechanical ventilation (19.5% vs. 40.6%; p < 0.001) and develop higher rates of ARDS (3.1% vs. 1.0 %; p < 0.001) compared to patients treated conservatively [ 19 ]. However, the authors posit that this is likely attributed to a marker of severe injury as these patients were more likely to have FC and high ISS [ 19 ].…”

“…Amongst in-hospital patients, those who underwent surgical stabilization were found to require longer HLOS (5.0 vs 13.0 days; p < 0.001), ICU LOS (4.0 vs 8.0 days; p < 0.001), mechanical ventilation (19.5% vs. 40.6%; p < 0.001) and develop higher rates of ARDS (3.1% vs. 1.0 %; p < 0.001) compared to patients treated conservatively [ 19 ]. However, the authors posit that this is likely attributed to a marker of severe injury as these patients were more likely to have FC and high ISS [ 19 ]. Mortality rates, however, were lower in patients who underwent surgical stabilization compared to patients managed conservatively (2.5% vs. 4.8%, p < 0.001) [ 19 ].…”

“…However, the authors posit that this is likely attributed to a marker of severe injury as these patients were more likely to have FC and high ISS [ 19 ]. Mortality rates, however, were lower in patients who underwent surgical stabilization compared to patients managed conservatively (2.5% vs. 4.8%, p < 0.001) [ 19 ]. Similar findings were reported in a retrospective cohort study by Farquhar and colleagues [ 20 ].…”