Beyond 72 Hours: A Retrospective Evaluation of Factors Associated With Delayed Surgical Stabilization of Rib...

Surgical stabilization of rib fractures (SSRF) is recognized as a key intervention in reducing morbidity among patients with multiple displaced rib fractures or flail chest. Early SSRF, typically within 72 hours of admission, has been associated with improved outcomes. The factors contributing to delayed stabilization, defined as 72 hours or greater following admission, remain unclear.

A retrospective cohort study was performed, evaluating 492 trauma patients who underwent SSRF at a level II trauma center. Patient demographics, injury characteristics, and associated injuries were analyzed to identify factors associated with delayed SSRF. Groups were defined as early (≤72 hours) and delayed (>72 hours). Regression analysis was used to identify independent predictors of delay. Correlations between time to operation and hospital outcomes were evaluated. A p-value of <0.05 was considered significant.

Of 492 patients, the median age was 66 years, and 301 (61%) were male; 122 (24.8%) patients underwent SSRF beyond 72 hours from admission. On univariate analysis, there was no difference in age, number of rib fractures, presence of flail chest, or anticoagulation status between groups. Delayed intervention was associated with higher ISS (19 vs 15, p<0.001), lower admission GCS (p<0.001), and need for craniotomy (p=0.002). On multivariate analysis, only injury severity score (ISS) independently predicted surgical delay (p=0.002, CI 1.01-1.07). Delayed SSRF correlated with longer hospital stay (p<0.001) but not ICU stay (p=0.876). Inpatient mortality did not differ significantly between early and delayed groups (1.6% vs. 4.1%, p=0.110).

Following a retrospective review of nearly 500 patients undergoing SSRF for severe flail and non-flail chest wall injury at a single institution, the ISS was found to be associated with delayed intervention beyond 72 hours of admission. Despite the known potential for increased risk of delayed chest wall stabilization, ICU stay, and inpatient mortality were found to be similar between early and delayed SSRF.