Surgical versus nonsurgical interventions for flail chest

Catâneo, Antônio José Maria; Catâneo, Daniele Cristina; Oliveira, Frederico Henrique Sobral de; Arruda, Karine Aparecida; Dib, Regina El; Carvalho, Paulo Eduardo de Oliveira

doi:10.1002/14651858.cd009919.pub2

Cited by 81 publications

(93 citation statements)

References 36 publications

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“…A comparable systematic review was published in July 2015 by Cataneo et al [18]. This systematic review included the same RCTs that were included in our study.…”

Section: Discussionmentioning

confidence: 94%

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

Schuurmans

Goslings

Schepers

2016

Eur J Trauma Emerg Surg

117

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PurposeFlail chest is a life-threatening complication of severe chest trauma with a mortality rate of up to 15 %. The standard non-operative management has high comorbidities with pneumonia and often leads to extended Intensive Care Unit (ICU) stay, due to insufficient respiratory function and complications. The aim of this literature study was to investigate how operative management improves patient care for adults with flail chest.MethodsRandomized-controlled trials comparing operative management versus non-operative management of flail chest were included in this systematic review and meta-analysis. PubMed, Trip Database, and Google Scholar were used for study identification. We compared operative-to-non-operative management in adult flail chest patients. Mean difference and risk ratio for mortality, pneumonia rate, duration of mechanical ventilation, duration of ICU stay, duration of hospital stay, tracheostomy rate, and treatment costs were calculated by pooling these publication results.ResultsThree randomized-controlled trials were included in this systematic review. In total, there were 61 patients receiving operative management compared to 62 patients in the non-operative management group. A positive effect of surgical rib fracture fixation was observed for pneumonia rate [ES 0.5, 95 % CI (0.3, 0.7)], duration of mechanical ventilation (DMV) [ES −6.5 days 95 % CI (−11.9, −1.2)], duration of ICU stay [ES −5.2 days 95 % CI (−6.2, −4.2)], duration of hospital stay (DHS) [ES −11.4 days 95 % CI (−12.4, −10.4)], tracheostomy rate (TRCH) [ES 0.4, 95 % CI (0.2, 0.7)], and treatment costs (saving $9.968,00–14.443,00 per patient). No significant difference was noted in mortality rate [ES 0.6, 95 % CI (0.1, 2.4)] between the two treatment strategies.ConclusionsDespite the relatively small number of patients included, different methodologies and differences in presentation of outcomes, operative management of flail chest seems to be a promising treatment strategy that improves patients’ outcomes in various ways. However, the effect on mortality rate remains inconclusive. Therefore, research should continue to explore operative management as a viable method for flail chest injuries.

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“…A comparable systematic review was published in July 2015 by Cataneo et al [18]. This systematic review included the same RCTs that were included in our study.…”

Section: Discussionmentioning

confidence: 94%

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

Schuurmans

Goslings

Schepers

2016

Eur J Trauma Emerg Surg

117

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“…Metal plates, intramedullary devices, and encircling wires are implants that are designed to increase chest wall stability supporting the healing process and thereby correction of chest wall deformity [11][12][13][14]. More and more evidence shows the benefits of surgical fixation of flail chests over non-operative management [15][16][17][18]. Although recent evidence-based guidelines advise surgical fixation in flail chest patients [19,20], the benefit of rib fixation is not unanimous and needs more comparative studies [21,22].…”

Section: Introductionmentioning

confidence: 99%

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

Wijffels

Hagenaars

Latifi

et al. 2018

Eur J Trauma Emerg Surg

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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.

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“…This treatment had meaningful results, suggesting that the surgical fixation of the fractured ribs could lead to significant benefits. On the other hand, Cataneo et al [19] found evidence in three studies with flail chest patients that non-surgical treatment is better than surgical management. They found fewer cases with pneumonia, thoracic deformities, tracheostomy incidence, mechanical ventilation and their ICU duration ( Figure 3).…”

Section: Flail Chestmentioning

confidence: 99%

Chest Trauma: An Overview

2015

JACCOA

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Surgical versus nonsurgical interventions for flail chest

Cited by 81 publications

References 36 publications

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

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

Chest Trauma: An Overview

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