TY - JOUR
T1 - Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation
T2 - An international, retrospective matched case-control study
AU - Prins, Jonne T.H.
AU - Van Lieshout, Esther M.M.
AU - Eriksson, Evert A.
AU - Barnes, Matthew
AU - Blokhuis, Taco J.
AU - Caragounis, Eva Corina
AU - Christie, D. Benjamin
AU - De Loos, Erik R.
AU - DeVoe, William B.
AU - Formijne Jonkers, Henk A.
AU - Kiel, Brandon
AU - Ko, Huan Jang
AU - Marasco, Silvana F.
AU - Spanjersberg, Willem R.
AU - Su, Ying Hao
AU - Summerhayes, Robyn G.
AU - Van Huijstee, Pieter J.
AU - Vermeulen, Jefrey
AU - Vos, Dagmar I.
AU - Verhofstad, Michael H.J.
AU - Wijffels, Mathieu M.E.
N1 - Publisher Copyright:
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Funding Information:
E.A.E. is a paid speaker for Synthes. W.B.D. is a consultant and lecturer for Acute Innovations, Acumed. S.F.M. receives lecture fees from Johnson & Johnson and Zimmer-Biomet. M.M.E.W. and E.M.M.V.L. report grants from the Netherlands Organization for Health Research and Development (ZonMw), DePuySynthes, Stichting Coolsingel, and Osteosynthesis and Trauma Care Foundation, outside the submitted work. All other authors declare no conflict of interest.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/12
Y1 - 2022/12
N2 - BACKGROUND: The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR. METHODS: An international, retrospective study was performed in patients who underwent SSRF or nonoperative management for multiple rib fractures following CPR between January 1, 2012, and July 31, 2020. Patients who underwent SSRF were matched to nonoperative controls by cardiac arrest location and cause, rib fracture pattern, and age. The primary outcome was ICU LOS. RESULTS: Thirty-nine operatively treated patient were matched to 66 nonoperatively managed controls with comparable CPR-related characteristics. Patients who underwent SSRF more often had displaced rib fractures (n = 28 [72%] vs. n = 31 [47%]; p = 0.015) and a higher median number of displaced ribs (2 [P 25 -P 75 , 0-3] vs. 0 [P 25 -P 75 , 0-3]; p = 0.014). Surgical stabilization of rib fractures was performed at a median of 5 days (P 25 -P 75 , 3-8 days) after CPR. In the nonoperative group, a rib fixation specialist was consulted in 14 patients (21%). The ICU LOS was longer in the SSRF group (13 days [P 25 -P 75 , 9-23 days] vs. 9 days [P 25 -P 75 , 5-15 days]; p = 0.004). Mechanical ventilator-free days, hospital LOS, thoracic complications, and mortality were similar. CONCLUSION: Despite matching, those who underwent SSRF over nonoperative management for multiple rib fractures following CPR had more severe consequential chest wall injury and a longer ICU LOS. A benefit of SSRF on in-hospital outcomes could not be demonstrated. A low consultation rate for rib fixation in the nonoperative group indicates that the consideration to perform SSRF in this population might be associated with other nonradiographic or injury-related variables. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
AB - BACKGROUND: The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR. METHODS: An international, retrospective study was performed in patients who underwent SSRF or nonoperative management for multiple rib fractures following CPR between January 1, 2012, and July 31, 2020. Patients who underwent SSRF were matched to nonoperative controls by cardiac arrest location and cause, rib fracture pattern, and age. The primary outcome was ICU LOS. RESULTS: Thirty-nine operatively treated patient were matched to 66 nonoperatively managed controls with comparable CPR-related characteristics. Patients who underwent SSRF more often had displaced rib fractures (n = 28 [72%] vs. n = 31 [47%]; p = 0.015) and a higher median number of displaced ribs (2 [P 25 -P 75 , 0-3] vs. 0 [P 25 -P 75 , 0-3]; p = 0.014). Surgical stabilization of rib fractures was performed at a median of 5 days (P 25 -P 75 , 3-8 days) after CPR. In the nonoperative group, a rib fixation specialist was consulted in 14 patients (21%). The ICU LOS was longer in the SSRF group (13 days [P 25 -P 75 , 9-23 days] vs. 9 days [P 25 -P 75 , 5-15 days]; p = 0.004). Mechanical ventilator-free days, hospital LOS, thoracic complications, and mortality were similar. CONCLUSION: Despite matching, those who underwent SSRF over nonoperative management for multiple rib fractures following CPR had more severe consequential chest wall injury and a longer ICU LOS. A benefit of SSRF on in-hospital outcomes could not be demonstrated. A low consultation rate for rib fixation in the nonoperative group indicates that the consideration to perform SSRF in this population might be associated with other nonradiographic or injury-related variables. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
UR - http://www.scopus.com/inward/record.url?scp=85142403556&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000003769
DO - 10.1097/TA.0000000000003769
M3 - Article
C2 - 36001117
AN - SCOPUS:85142403556
SN - 1079-6061
VL - 93
SP - 727
EP - 735
JO - The journal of trauma and acute care surgery
JF - The journal of trauma and acute care surgery
IS - 6
ER -