Fixation of rib fractures is beneficial for patients with chronic obstructive pulmonary disease, a trauma quality
Chien-An Liao1,2,3, Chih-Po Hsu1,2, Jen-Fu Huang1,2
1Department of Trauma and Emergency Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kwei-Shan District, Taoyuan, Taiwan.
Background:
Internal fixation for multiple rib fractures is well established. Patients with underlying chronic obstructive pulmonary disease (COPD) have a higher rate of perioperative complications. It is unclear if these patients are suitable candidates for internal fixation and if surgical interventions are harmful to these patients.
Study Design And Methods:
Adult patients with ≥ 3 rib fractures and underlying COPD from the Trauma Quality Improvement Program between 2017 and 2019 were eligible for inclusion. The patients were divided into two treatment groups: operative and non-operative. Furthermore, inverse probability treatment weighting was applied to analyze mortality and adverse hospital events.
Results:
Patients with COPD in the operative group had higher ventilator use (odds ratio [OR], 3.211; 95% confidence interval [CI], 1.993-5.175; p < 0.001). Additionally, they had a longer length of stay (coefficient β, 4.139; standard error, 0.829; p < 0.001) and longer ventilator days (coefficient β, 1.937; standard error, 0.655; p = 0.003) than in the non-operative group. Furthermore, the mortality rate was lower in the operative group than in the non-operative group (OR, 0.426; 95% CI, 0.228-0.798; p = 0.008).
Conclusion:
Internal fixation of rib fractures plays a crucial role in patients with underlying COPD disease. They presented a better mortality rate without an increased perioperative complication rate.
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