A decade of surgical stabilization of rib fractures: the effect of study year on patient selection, operative characteristics, and in-hospital outcome

Jonne T.H. Prins*, Kiara Leasia, Angela Sauaia, Clay C. Burlew, Mitchell J. Cohen, Jamie J. Coleman, Ryan A. Lawless, K. Barry Platnick, Nicole L. Werner, Mathieu M.E. Wijffels, Ernest E. Moore, Fredric M. Pieracci

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
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Background: Many centers now perform surgical stabilization of rib fractures (SSRF). This single center study aimed to investigate temporal trends by year in patient selection, operative characteristics, and in-hospital outcomes We hypothesized that, over time, patient selection, time to SSRF, operative time, and in-hospital outcomes varied significantly. Methods: A retrospective review of a prospectively maintained SSRF database (2010 to 2020) was performed. Patients were stratified by year in which they underwent SSRF. The primary outcome was operative time, defined in minutes from incision to closure. Secondary outcomes were patient and operative characteristics, and in-hospital outcomes. Multivariable regression analyses were performed to assess for temporal trends, corrected for confounders. The outcomes ventilator-, Intensive Care Unit-, and hospital-free days (VFD, IFD, and HFD, respectively) were categorized based on the group's medians, and complications were combined into a composite outcome. Results: In total, 222 patients underwent SSRF on a median of one day after admission (P25-P75, 0-2). Patients had a median age of 54 years (P25-P75, 42-63), ISS of 19 (P25-P75, 13-26), RibScore of 3 (P25-P75, 2-5), and sustained a median of 8 fractured ribs (P25-P75, 6-11). In multivariable analysis, increasing study year was associated with an increase in operative time (p<0.0001). In addition, study year was associated with a significantly reduced odds of complications (Odds ratio [OR], 0.76; 95% Confidence Interval [95% CI], 0.63-0.92; p=0.005), VFD < 28 days (OR, 0.77; 95% CI, 0.65-0.92; p=0.003), IFD < 24 days (OR, 0.77; 95% CI, 0.66-0.91; p=0.002), and HFD < 18 days (OR, 0.64; 95% CI, 0.53-0.76; p<0.0001). Conclusion: In-hospital outcomes after SSRF improved over time. Unexpectedly, operative time increased. The reason for this finding is likely multifactorial and may be related to patient selection, onboarding of new surgeons, fracture characteristics, and minimally invasive exposures. Due to potential for confounding, study year should be accounted for when evaluating outcomes of SSRF.

Original languageEnglish
Pages (from-to)1637-1644
Number of pages8
Issue number5
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
EMMVL and MMEW report grants from the Netherlands Organization for Health Research and Development (ZonMw), DepuySynthes, Stichting Coolsingel, and Ostheosynthesis and Trauma Care Foundation, outside the submitted work. All other authors declare no conflict of interest.

Publisher Copyright:
© 2021 Elsevier Ltd


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