Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization

Abstract

Background: In polytrauma (PT) patients, osseous thoracic injuries are commonly observed. One of the most severe injuries is the flail chest where the rib cage is broken in such a way that leads to a partial functional detachment of the thoracic wall. Especially in PT patients, the integrity of the respiratory system and especially, of the respiratory muscles is essential to prevent respiratory failure. Besides conservative treatment options, flail chest injuries may be surgically stabilized. However, this treatment option is rarely carried out and evidence on the outcome of surgically treated flail chest patients is rare. Objective: This study intends to investigate the clinical outcome of PT patients with the diagnosis of a flail chest who received an osteosynthetic stabilization for that compared to the same group of patients without an operative treatment. The between-groups outcome was compared regarding the duration of the total hospital and the intensive care unit (ICU) stay, the total of the invasive ventilation days, the incidence of pneumonia, and the dosage of the pain medication at the hospital discharge. Methods: A retrospective analysis was conducted including all PT patients who received an osteosynthetic stabilization of a flail chest. Furthermore, another cohort of PT patients and the diagnosis of a flail chest but without operative treatment was determined. Both groups were case-control matched for the Injury Severity Score (ISS) and age. Further statistical analysis was performed using the Wilcoxon signed-rank test and the McNemar’s test. Results: Out of eleven operatively and 59 conservatively treated patients, eleven patients per group were matched. Further analysis revealed no significant differences in the normal ward treatment duration (5.64 ± 6.62 and 6.20 ± 5.85 days), the invasive ventilation duration (was 6.25 ± 7.17 and 7.10 ± 6.14 days), the morphine equivalent dosage of the oral analgesia (61.36 ± 67.23 mg and 39.67 ± 65.65 mg), and the pneumonia incidence (36.4 and 54.5%) when conservatively and operatively treated patients were compared, respectively. However, surgically treated patients had a longer ICU (25.18 ± 14.48 and 15.27 ± 12.10 days, Z = −2.308, p = 0.021) and a longer total hospital treatment duration (30.10 ± 13.01 and 20.91 ± 10.34 days, Z = −2.807, p = 0.005) when compared to conservatively treated patients. Conclusion: In the present study cohort, there was no outcome difference between conservatively and operatively treated patients with the diagnosis of a flail chest regarding the normal ward treatment duration, the invasive ventilation duration, the morphine equivalent dosage of the oral analgesia, and the pneumonia incidence while ICU treatment duration and hospital treatment duration was longer in operatively treated patients.

Abstracts der Gewinner der Nachwuchsförderung der AO Trauma Deutschland im Rahmen der 51. Jahrestagung 2023

“…Aufgrund inhomogener chirurgischer Strategien und kaum vergleichbarer Kollektive ist die bisherige Datenlage hinsichtlich der Indikation zur frühzeitigen Osteosynthese von Segmentverletzungen der Rippen inkonklusiv. Auch eine retrospektive Studie aus unserem Zentrum zeigte ein annähernd gleiches Outcome zwischen operativ und konservativ Behandelten 5 . Es muss jedoch angemerkt werden, dass die Indikation zur Osteosynthese in unserem Zentrum bislang als letzte Therapieoption gestellt wird.…”

New Diagnostic and Therapeutic Approaches for the Care of the Severely Injured Patient

“…In their retrospective study, Niemann et al did not find differences in clinical parameters (e.g., the duration of mechanical ventilation, analgesia requirements, pneumonia incidence) between conservatively and operatively treated patients. However, a prolongation of both the length of intensive care unit (ICU) stay and hospital treatment duration was observed in operatively treated patients [5]. In a further study with a retrospective design, Eckhardt et al confirmed the relevance of chest trauma in the posttraumatic course (longer ventilation time, prolonged ICU stay, increased mortality) Interestingly, being overweight resulted in an independent mortality reduction in patients with severe chest trauma [6].…”