Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide...

The effectiveness of surgical rib fixation is currently controversial, partly because of differences in timing. We used a Japanese nationwide database to investigate the effectiveness of surgical rib fixation in relation to its timing.

We used the Japanese Diagnosis Procedure Combination database to identify patients with rib fractures who underwent mechanical ventilation from 1 July 2010 to 31 March 2018. We performed overlap weight analysis to compare in-hospital outcomes between patients who had and had not undergone surgical rib fixation within 3, 6 or 10 days after admission. The primary outcomes were duration of mechanical ventilation and post-rib fixation length of hospital stay. The secondary outcomes were tracheostomy, post-admission pneumonia and all-cause 28-day in-hospital mortality.

We identified 8922 eligible patients. Surgical rib fixation within 3 days after admission was associated with shorter duration of mechanical ventilation (percent difference, - 42.9%; 95% confidence interval, - 57.4 to - 23.3) and shorter hospital stay (percent difference, - 19.6%; 95% confidence interval, - 31.8 to - 5.2). There were no significant differences between the groups in tracheostomy (risk difference, - 0.04; 95% confidence interval, - 0.15 to 0.07), post-admission pneumonia (risk difference, - 0.04; 95% confidence interval, - 0.13 to 0.05) or all-cause 28-day in-hospital mortality (risk difference, - 0.02; 95% confidence interval, - 0.07 to 0.03). However, there were no significant differences in any in-hospital outcomes between those who had and had not undergone rib fixation within 6 or 10 days after admission.

Early surgical rib fixation was associated with better in-hospital outcomes, whereas later surgical rib fixation was not.