Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study

Otaka, Shunichi; Aso, Shotaro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1007/s00068-020-01548-1

Cited by 16 publications

(19 citation statements)

References 30 publications

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“…The following study was a single center retrospective cohort study of 95 patients who underwent SSRF, stratified by number of hospital days to SSRF (0-2, 3-4, 5-6, and >6 days) (81). These SSRF groups were compared to patients who were treated nonoperatively, matched in a 1:2 ratio by (82). There was no information on rib fracture severity or operative characteristics.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Current practice management guidelines for SSRF both advocate early operative fixation (≤72 hours, once other lifethreatening injuries have been identified and stabilized) to reduce HLOS, ICU-LOS, DMV, and rate of mechanical ventilation requirement, pneumonia, and tracheostomy (36,37). While only the first study was available at the time of developing these guidelines, the more recently published studies corroborate this consensus of early SSRF benefit (75,(78)(79)(80)(82)(83)(84)89). In addition, early SSRF appears to be safe and also beneficial in elderly patients for all outcomes and is associated with lower hospitalization costs (80,83,84).…”

Section: Commentsmentioning

confidence: 99%

“…In addition, early SSRF appears to be safe and also beneficial in elderly patients for all outcomes and is associated with lower hospitalization costs (80,83,84). Interestingly, recent studies have also suggested that while early fixation within 2-3 days after admission is associated with improved in-hospital outcomes, performing SSRF after this time period might actually correlate with outcomes inferior to nonoperative management (81,82). This might be associated to exposing the patient to the risks of surgery without the benefit of early fixation such as improving chest wall stability, evacuation of hemothorax or trans positioned chest wall tissue, and possible prevention of pneumonia and a lengthy hospitalization.…”

Section: Commentsmentioning

confidence: 99%

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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: Literature Reviewmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

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

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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“…Additionally, Majak and Naess stated that SSRF within the first 72 h might lead to a better outcome ( 28 ). The Japanese group around Otaka was able to demonstrate an association of a better in-hospital outcome for early surgical fixations, whereas later surgical fixation was not ( 29 , 30 ). The first review article discussing early vs. late SSRF was published by Radomski and Pieracci in 2019, stating that an early SSRF within 72 h should be achieved but was only based on three publications at this point of time ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry

et al. 2022

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PurposeIn severely injured patients with multiple rib fractures, the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results, and the indication and especially the right timing of an operation are the subject of a broad discussion. The aim of this study was to determine the influence of the time point of surgical stabilization of rib fractures (SSRF) on the outcome in a multicenter database with special regard to the duration of ventilation, intensive care, and overall hospital stay.MethodsData from the TraumaRegister DGU collected between 2010 and 2019 were used to evaluate patients above 16 years of age with severe rib fractures [Abbreviated Injury Score (AIS) ≥ 3] who received an SSRF in a matched-pairs analysis. In this matched-pairs analysis, we compared the effects of an early SSRF within 48 h after initial trauma vs. late SSRF 3–10 days after trauma.ResultsAfter the selection process, we were able to find 142 matched pairs for further evaluation. Early SSRF was associated with a significantly shorter length of stay in the intensive care unit (16.2 days vs. 12.7 days, p = 0.020), and the overall hospital stay (28.5 days vs. 23.4 days, p = 0.005) was significantly longer in the group with late SSRF. Concerning the days on mechanical ventilation, we were able to demonstrate a trend for an approximately 1.5 day shorter ventilation time for patients after early SSRF, although this difference was not statistically significant (p = 0.226).ConclusionsWe were able to determine the significant beneficial effects of early SSRF resulting in a shorter intensive care unit stay and a shorter length of stay in hospital and additionally a trend to a shorter time on mechanical ventilation.

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“…With high rates of mGCS score recovery to 6 and a low complication rate, SSRF and the consequent perioperative setting is safe and does not hamper neurological recovery. This is of importance as early SSRF (≤ 48-72 h after trauma) is associated with shorter HLOS, ICU LOS, mechanical ventilation duration, and lower rates of pneumonia [30][31][32]. With a median time from trauma to SSRF of 2 and 3 days in patients with a non-flail fracture pattern and a flail chest, respectively, this benefit of early SSRF might already be present.…”

Section: Discussionmentioning

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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Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study

Cited by 16 publications

References 30 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?

Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry

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

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