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Rib fractures in frail geriatric patients: Does surgical stabilization improve outcomes?
Bardiya Zangbar1, Riddhi Mehta, Kartik Prabhakaran
1From the Department of Trauma and Acute Care Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Background:
Frail geriatric patients with multiple rib fractures face significant morbidity. While surgical stabilization of rib fractures (SSRF) has demonstrated improved outcomes in adults, its efficacy in frail patients remains unclear. We aimed to compare in-hospital outcomes between SSRF and nonoperative management in frail geriatric patients, hypothesizing that SSRF would be associated with lower complications and mortality.
Methods:
A 6-year (2017-2022) retrospective analysis of Trauma Quality Improvement Program database was conducted. Frailty was defined using an 11-factor modified frailty index (mFI) with threshold of ≥0.25. Frail patients ≥65 years with isolated blunt thoracic trauma and ≥2 rib fractures were included. 1:1 propensity score matching adjusted for demographics, injury severity, and baseline characteristics. Primary outcomes were mortality, ventilator-associated pneumonia, acute respiratory distress syndrome, unplanned intubation, intensive care unit (ICU) readmission, and tracheostomy. Secondary outcomes included in-hospital complications, length of stay (LOS), and discharge disposition. PS-matched subanalysis compared early SSRF (≤72 hours) to late SSRF (>72 hours).
Results:
Among 53,630 frail rib fracture patients, 2% underwent SSRF. After propensity score matching (1,063 each), SSRF was associated with lower mortality (5.4% vs. 10.2%, p < 0.001) but showed no differences in ventilator-associated pneumonia, acute respiratory distress syndrome, or tracheostomies. Surgical stabilization of rib fracture patients had higher ICU readmission and longer hospital and ICU LOS ( p < 0.05 for all). In the sub-analysis (n = 916), late SSRF was associated with increased unplanned intubation (10.7% vs. 6.8%), ICU readmissions (15.5% vs. 7.6%), tracheostomy (7.0% vs. 3.5%), and longer hospital LOS (13 days vs. 10 days.), ICU LOS (8 days vs. 6 days) and ventilator days (7 days vs. 4 days.) ( p < 0.001 for all).
Conclusion:
Surgical stabilization of rib fracture is associated with reduced mortality in frail geriatric patients with multiple rib fractures without increasing major complications when compared with nonoperative management. Early SSRF within 72 hours is associated with decreased unplanned intubation, ICU readmission, tracheostomy, LOS, and ventilator requirement in frail patients.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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