Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: A US hospital matched cohort database analysis.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
pubmed:
3
2
2023
medline:
25
3
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design. Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links. A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245). Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up. Therapeutic/Care Management; Level III.
Sections du résumé
BACKGROUND
Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design.
METHODS
Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links.
RESULTS
A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245).
CONCLUSION
Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Identifiants
pubmed: 36730674
doi: 10.1097/TA.0000000000003828
pii: 01586154-202304000-00006
pmc: PMC10045967
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
538-545Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.
Références
Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery . 2005;138(4):717–723; discussion 723-5.
Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg . 2014;76(2):462–468.
Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg . 2013;205(5):511–515; discusssion 515–6.
Serfin JA, Guo WA. Rib fractures. the American Association for the Surgery of Trauma. Last accessed: 6/20/2022.
Chen Zhu R, de Roulet A, Ogami T, Khariton K. Rib fixation in geriatric trauma: mortality benefits for the most vulnerable patients. J Trauma Acute Care Surg . 2020;89(1):103–110.
Peek J, Beks RB, Hietbrink F, De Jong MB, Heng M, Beeres FJP, et al. Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands. Eur J Trauma Emerg Surg . 2022;48(1):265–271.
Sawyer E, Wullschleger M, Muller N, Muller M. Surgical rib fixation of multiple rib fractures and flail chest: a systematic review and meta-analysis. J Surg Res . 2022;276:221–234.
Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury . 2012;43(1):8–17.
Kim M, Moore JE. Chest trauma: current recommendations for rib fractures, pneumothorax, and other injuries. Curr Anesthesiol Rep . 2020;10(1):61–68.
Beks RB, de Jong MB, Houwert RM, Sweet AAR, De Bruin IGJM, Govaert GAM, et al. Long-term follow-up after rib fixation for flail chest and multiple rib fractures. Eur J Trauma Emerg Surg . 2019;45(4):645–654.
Beks RB, Reetz D, de Jong MB, Groenwold RHH, Hietbrink F, Edwards MJR, et al. Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study. Eur J Trauma Emerg Surg . 2019;45(4):655–663.
Peek J, Beks RB, Hietbrink F, Heng M, De Jong MB, Beeres FJP, et al. Complications and outcome after rib fracture fixation: a systematic review. J Trauma Acute Care Surg . 2020;89(2):411–418.
Long R, Tian J, Wu S, Li Y, Yang X, Fei J. Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: a meta-analysis of randomized controlled trials. Int J Surg . 2020;83:79–88.
Fitzpatrick DC, Denard PJ, Phelan D, Long WB, Madey SM, Bottlang M. Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg . 2010;36(5):427–433.
Jiang Y, Wang X, Teng L, Liu Y, Wang J, Zheng Z. Comparison of the effectiveness of surgical versus nonsurgical treatment for multiple rib fractures accompanied with pulmonary contusion. Ann Thorac Cardiovasc Surg . 2019;25(4):185–191.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care . 1998;36(1):8–27.
Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res . 2014;472(9):2878–2886.
Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of injury severity score, new injury severity score, revised trauma score and trauma and injury severity score for mortality prediction in elderly trauma patients. Indian J Crit Care Med . 2019;23(2):73–77.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med . 2009;28(25):3083–3107.
Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the eastern Association for the Surgery of trauma. J Trauma Acute Care Surg . 2017;82(3):618–626.
Pieracci FM, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards JG, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury . 2017;48(2):307–321.
Green EA, Guidry C, Harris C, McGrew P, Schroll R, Hussein M, et al. Surgical stabilization of traumatic rib fractures is associated with reduced readmissions and increased survival. Surgery . 2021;170(6):1838–1848.
Liang YS, Yu KC, Wong CS, Kao Y, Tiong TY, Tam KW. Does surgery reduce the risk of complications among patients with multiple rib fractures? A meta-analysis. Clin Orthop Relat Res . 2019;477(1):193–205.
Liu Y, Xu S, Yu Q, Tao Y, Peng L, Qi S, et al. Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis. Ann Transl Med . 2018;6(22):439.
Beks RB, Peek J, de Jong MB, Wessem KJP, Öner CF, Hietbrink F, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg . 2019;45(4):631–644.
Austin PC, Mamdani MM. A comparison of propensity score methods: a case-study estimating the effectiveness of post-AMI statin use. Stat Med . 2006;25(12):2084–2106.
Desai RJ, Rothman KJ, Bateman BT, Hernandez-Diaz S, Huybrechts KF. A propensity-score-based fine stratification approach for confounding adjustment when exposure is infrequent. Epidemiology . 2017;28(2):249–257.
Esposito DB, Huybrechts KF, Werler MM, Straub L, Hernández-Díaz S, Mogun H, et al. Characteristics of prescription opioid analgesics in pregnancy and risk of neonatal opioid withdrawal syndrome in newborns. JAMA Netw Open . 2022;5(8):e2228588.
Ettleson MD, Bianco AC, Wan W, Laiteerapong N. Suboptimal thyroid hormone replacement is associated with worse hospital outcomes. J Clin Endocrinol Metab . 2022;107(8):e3411–e3419.
Lo Re V 3rd, Dutcher SK, Connolly JG, Perez-Vilar S, Carbonari DM, DeFor TA, et al. Association of COVID-19 vs influenza with risk of arterial and venous thrombotic events among hospitalized patients. JAMA . 2022;328(7):637–651.
Beks RB, de Jong MB, Sweet A, Peek J, van Wageningen B, Tromp T, et al. Multicentre prospective cohort study of nonoperative versus operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: study protocol. BMJ Open . 2019;9(8):e023660.