Late Operative Rib Fixation is Inferior to Nonoperative Management
Kevin N Harrell1, Robert J Jean1, S Dave Bhattacharya1
1Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA.
The American Surgeon
|August 26, 2020
Summary
Early operative rib fixation (ORF) for traumatic rib fractures significantly reduces hospital length of stay and ventilator days. Prompt surgical intervention, within 0-2 days, yields better outcomes compared to delayed fixation, improving patient recovery.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Operative rib fixation (ORF) is associated with reduced hospital length of stay (LOS), ventilator days, and mortality in traumatic rib fractures.
- Early ORF (within 1 day of admission) demonstrates more favorable outcomes than delayed ORF.
- This study reviews a decade of ORF experience at a Level I trauma center.
Purpose of the Study:
- To examine the outcomes of operative rib fixation (ORF) over a 10-year period.
- To compare early versus delayed ORF timing.
- To assess the impact of ORF on hospital LOS, ICU LOS, ventilator days, and mortality.
Main Methods:
- A 1:2 matched cohort study comparing ORF patients to nonoperative controls (January 2007-January 2018).
- Matching criteria included age, Injury Severity Score (ISS), chest Abbreviated Injury Score (AIS), and head AIS.
- Data on demographics, injuries, and outcomes were extracted from trauma registry and medical records.
Main Results:
- Ninety-five ORF patients were matched with 190 nonoperative controls.
- ORF patients presented with a higher number of rib fractures (9.6 vs. 6.4, P < .001).
- Early ORF (0-2 days) resulted in shorter hospital stays (11.8 days) compared to delayed fixation (12.6-19.6 days, P = .003). Delayed ORF (3-4 days and >6 days) correlated with longer ICU LOS and ventilator days, and increased mortality when performed after 6 days.
Conclusions:
- Early operative rib fixation (ORF) may enhance pulmonary function and patient outcomes while reducing hospital LOS.
- A shift towards earlier ORF implementation is recommended to maximize its benefits in treating blunt chest trauma.
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