Operative Treatment of Flail Chest Injuries Does Not Reduce Pain or In-Hospital Opioid Requirements: Results from a...

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Orthopedic Surgery

Background:

• A prior RCT indicated more ventilator-free days with operative treatment for flail chest.
• Surgery for flail chest may potentially improve pain and function.
• This study aimed to analyze pain and opioid use in operatively vs. nonoperatively treated unstable chest wall injuries.

Purpose of the Study:

• To conduct a secondary analysis of a randomized controlled trial (RCT).
• To evaluate and compare pain and postinjury opioid requirements between operative and nonoperative treatment groups for unstable chest wall injuries.

Main Methods:

• Analysis of data from a multicenter RCT (2011-2019) involving patients with acute, unstable chest wall injuries.
• Patients were randomized to operative or nonoperative treatment.
• In-hospital pain medication logs (morphine milligram equivalents), patient-reported symptoms (pain, shortness of breath), and SF-36 scores were assessed up to 1 year postinjury.

Main Results:

• No significant differences in daily opioid usage between operative and nonoperative groups (p = 0.477).
• No significant differences in generalized pain, chest wall pain, chest wall tightness, or shortness of breath between groups at any time point.
• Similar Short Form-36 (SF-36) scores were reported for both treatment groups.

Conclusions:

• Operative treatment for flail chest injuries did not reduce in-hospital opioid requirements.
• No significant improvements in pain or respiratory symptoms were observed with operative treatment compared to nonoperative management.
• Further research is necessary to identify patient subgroups who may benefit from operative intervention for flail chest injuries.