Isolated Thoracic Injury Patients With Rib Fractures Undergoing Rib Fixation Have Improved Mortality.

Adult Aged Female Humans Length of Stay Logistic Models Male Middle Aged Retrospective Studies Rib Fractures / surgery Thoracic Injuries / complications
Isolated Rib fixation Rib fractures Surgical stabilization of rib fractures Thoracic injury Thoracic trauma

Journal

The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340

Informations de publication

Date de publication:
06 2021
Historique:
received: 24 09 2020
revised: 28 12 2020
accepted: 18 01 2021
pubmed: 20 2 2021
medline: 24 9 2021
entrez: 19 2 2021
Statut: ppublish

Résumé

Despite a lack of consensus recommendations for surgical stabilization of rib fractures (SSRF), SSRF has increased over the past decade. Outcomes of patients with isolated thoracic injuries undergoing SSRF are unknown. We hypothesized adult trauma patients with isolated thoracic injuries and rib fractures undergoing SSRF would have a decreased risk of mortality and in-hospital respiratory complications compared with those not undergoing SSRF. The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting with a rib fracture. Patients who died in the emergency department or within 24-h, as well as those with a grade>1 for abbreviated injury scale of the head, face, neck, spine, abdomen, and extremities, were excluded. A multivariable logistic regression analysis was performed. From 60,000 patients with isolated thoracic injuries and rib fractures, 688 (1.1%) underwent SSRF. Compared with patients without SSRF, those undergoing SSRF had a similar median age (P = 0.83) and higher injury severity score (P < 0.001). Patients undergoing SSRF had a longer length of stay (P < 0.001), higher rate of acute respiratory distress syndrome (P < 0.001), unplanned intubation (P < 0.001), and pneumonia (P < 0.001) but lower rate of mortality (0.9% versus 1.7%, P = 0.084). After adjusting for confounding variables, patients undergoing SSRF had a decreased associated risk of mortality (OR 0.40, P = 0.036) compared with those not undergoing SSRF. The risk of mortality in trauma patients with isolated thoracic injuries and rib fractures is lower when undergoing SSRF despite being associated with a higher rate of respiratory complications during their increased length of stay.

Sections du résumé

BACKGROUND
Despite a lack of consensus recommendations for surgical stabilization of rib fractures (SSRF), SSRF has increased over the past decade. Outcomes of patients with isolated thoracic injuries undergoing SSRF are unknown. We hypothesized adult trauma patients with isolated thoracic injuries and rib fractures undergoing SSRF would have a decreased risk of mortality and in-hospital respiratory complications compared with those not undergoing SSRF.
MATERIALS AND METHODS
The Trauma Quality Improvement Program (2010-2016) was queried for patients presenting with a rib fracture. Patients who died in the emergency department or within 24-h, as well as those with a grade>1 for abbreviated injury scale of the head, face, neck, spine, abdomen, and extremities, were excluded. A multivariable logistic regression analysis was performed.
RESULTS
From 60,000 patients with isolated thoracic injuries and rib fractures, 688 (1.1%) underwent SSRF. Compared with patients without SSRF, those undergoing SSRF had a similar median age (P = 0.83) and higher injury severity score (P < 0.001). Patients undergoing SSRF had a longer length of stay (P < 0.001), higher rate of acute respiratory distress syndrome (P < 0.001), unplanned intubation (P < 0.001), and pneumonia (P < 0.001) but lower rate of mortality (0.9% versus 1.7%, P = 0.084). After adjusting for confounding variables, patients undergoing SSRF had a decreased associated risk of mortality (OR 0.40, P = 0.036) compared with those not undergoing SSRF.
CONCLUSIONS
The risk of mortality in trauma patients with isolated thoracic injuries and rib fractures is lower when undergoing SSRF despite being associated with a higher rate of respiratory complications during their increased length of stay.

Identifiants

DOI: 10.1016/j.jss.2021.01.016 PMID: 33607414
pubmed: 33607414
pii: S0022-4804(21)00043-3
doi: 10.1016/j.jss.2021.01.016
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

197-202

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Auteurs

Eric O Yeates (EO)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California. Electronic address: yeatese@hs.uci.edu.

Areg Grigorian (A)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Jeffry Nahmias (J)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Matthew Dolich (M)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Michael Lekawa (M)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Alliya Qazi (A)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Allen Kong (A)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

Sebastian D Schubl (SD)

Department of Trauma, Burns and Surgical Critical Care, University of California, Irvine Medical Center, Orange, California.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de régression › Modèles logistiques › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Fractures de côte › Isolated Thoracic Injury Patients With Rib...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Isolated Thoracic Injury Patients With Rib...