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

Prins, Jonne T H; Wijffels, Mathieu M E; Pieracci, Fredric M.

doi:10.21037/jtd-21-649

Cited by 46 publications

(42 citation statements)

References 88 publications

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“…We performed SSRF in our patients a median of 5 days post-injury. This could have impacted on outcomes, as early SSRF (within 3 days of admission) has been associated with shorter hospital and intensive length of stay, shorter duration of mechanical ventilation, and lower rates of pneumonia and tracheostomy [ 17 ]. Although we aim to perform SSRF as soon as practical, logistical constraints often delay progress to operative intervention and we have not improved on this over the 12 years of this study.…”

Section: Discussionmentioning

confidence: 99%

Flail chest injury—changing management and outcomes

Marasco

Khuong

Fitzgerald

et al. 2022

Eur J Trauma Emerg Surg

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Purpose The purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes. Methods A retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included. Results Our study included 720 patients, mean age was 59.5 ± 17.3 years old, and 76.5% of patients were male. Length of ICU stay decreased on average by 9 h each year. Regional anaesthesia use increased by 15% per year (0% in 2009 to 36% in 2020) (p < 0.001). Surgical stabilisation of rib fractures increased by 16% per year (2.9% in 2009 to 22.3% in 2020) (p = 0.006). The use of invasive ventilation decreased by 14% per year (70% in 2008 to 27% in 2020) (p < 0.001), and invasive ventilation time decreased by 8 h per year (p = 0.007). Conclusion Over the past decade, we have seen increasing rates of regional anaesthesia and surgical rib fixation in the management of flail chest. This has resulted in lower requirements for and duration of invasive mechanical ventilation and intensive care unit stay but has not impacted mortality in this patient cohort.

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Section: Discussionmentioning

confidence: 99%

Flail chest injury—changing management and outcomes

Marasco

Khuong

Fitzgerald

et al. 2022

Eur J Trauma Emerg Surg

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“…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 ). Prins et al as well concentrated their review on the time point of SSRF and were able to recommend early SSRF within 48 or 72 h the latest based on the total number of nine publications concerning this matter ( 32 ). In our matched-pairs analysis, we were able to confirm these results by determining the significant beneficial effects of early SSRF, resulting in a shorter ICU stay and a shorter length of stay (LOS) in the hospital and additionally a trend to a shorter time on mechanical ventilation.…”

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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“…On admission to the ICU, median ISS and SAPS II were 32 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 24 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] respectively. After total body-CTscan; the median number of rib fractures was 7 [6][7][8][9][10].…”

Section: Lesions Descriptionmentioning

confidence: 99%

When to proceed to surgical rib fixation?—A single-institution clinical experience

Belaroussi¹,

Drevet²,

Soldea³

et al. 2023

J Thorac Dis

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Background: Surgical rib fixation for multiple rib fractures and flail chest has become more common in the 2000s with interesting results in selected patients. However, surgical rib fixation lacks a consensus on the delay to surgery and the benefits on postoperative clinical outcomes. Our goal was to determine if delay to surgery can affect postoperative outcomes. Methods:We analyzed a retrospective database including all consecutive patients referred for surgical rib fixation. All outcomes were explored according to trauma mechanism, associated lesions, initial ventilatory status, delay to surgery, surgical technique and a specific focus was made towards post-operative care and pulmonary complications. Logistic regressions were performed to evaluate the association between delay to surgery [before 48 hours (early group), 48 hours to 7 days (mid group), more than 7 days (late group)] and pneumonia and failure of extubating.Results: From 2010 to 2020, 159 patients underwent surgical rib fixation. The median hospital length of stay was 18 days [interquartile range 13-30]. Pulmonary infections were encountered in 67 patients (42.2%) with about two third of early pneumonia (<5 days). The one-month mortality rate was 1.9%. Delay to surgery was not associated with either pneumonia (P>0.05) or failure of extubating (P>0.05).Conclusions: Surgical rib fixation can be delayed without increasing the risk of pulmonary complications.Stabilizing other clinical situations can be safely prioritized if needed. A global evaluation including characteristics of trauma and lung evaluation must be considered before surgical stabilization of rib fracture.

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

Cited by 46 publications

References 88 publications

Flail chest injury—changing management and outcomes

Flail chest injury—changing management and outcomes

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

When to proceed to surgical rib fixation?—A single-institution clinical experience

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