A MULTICENTER EVALUATION OF THE OPTIMAL TIMING OF SURGICAL STABILIZATION OF RIB FRACTURES.

The optimal timing of surgical stabilization of rib fractures (SSRF) remains debated. We hypothesized that 1) demographic, radiologic, and clinical variables are associated with time to surgery and 2), shorter time to SSRF improves acute outcomes. Prospectively collected SSRF databases from four trauma centers were merged and analyzed (2006-2016). The independent variable was days from hospital admission to SSRF [early (< 1 day), mid (1-2 days), and late (3-10 days)]. Outcomes included length of operation, number of ribs repaired, prolonged (> 24 hours) mechanical ventilation, pneumonia, tracheostomy, length of stay, and mortality. Multivariable logistic regression was used to control for significant differences in covariates between groups. 551 patients were analyzed. The median time to SSRF was 1 day (range 0-10); 207 (37.6%) patients were in the early group, 168 (30.5%) in the mid group, and 186 (31.9%) in the late group. There was a significant shift towards earlier SSRF over the study period. Time to SSRF was significantly associated with study center (p< 0.01), year of surgery (p<0.01), age (p=0.02), mechanism of injury (p=0.04), and body mass index (p=0.02). Injury severity was not associated with time to surgery. Despite repairing the same median number of ribs (4, range 1-13), median length of surgery was 68 minutes longer for the late as compared to the early group (p<0.01). After controlling for the aforementioned significant covariates, each additional hospital day prior to SSRF was independently associated with a 31% increased likelihood of pneumonia (p<0.01), a 27% increased likelihood of prolonged mechanical ventilation (p<0.01), and a 26% increased likelihood of tracheostomy (p<0.01). SSRF within 1 day of admission is associated with certain demographic and physiologic variables. After controlling for confounding factors, early SSRF was accomplished using less operative time, and was associated with favorable outcomes. When indicated and feasible, SSRF should occur as early as possible. Retrospective review of prospectively-collected databaseLEVEL OF EVIDENCE: Level III.

Citation

Fredric M Pieracci, Julia Coleman, Francis Ali-Osman, Alicia Mangram, Sarah Majercik, Thomas W White, Elan Jeremitsky, Andrew R Doben. A MULTICENTER EVALUATION OF THE OPTIMAL TIMING OF SURGICAL STABILIZATION OF RIB FRACTURES. The journal of trauma and acute care surgery. 2017 Oct 25

PMID: 29077677

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