Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: An international, retrospective matched case-control study.

Autor:	Prins JTH; From the Trauma Research Unit, Department of Surgery (J.T.H.P., E.M.M.V.L., M.H.J.V., M.M.E.W.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Trauma and Critical Care, Department of Surgery (E.A.E.), Medical University of South Carolina, Charleston, South Carolina; Department of Trauma Surgery/Critical Care (M.B., D.B.C.), Mercer University School of Medicine, The Medical Center, Navicent Health, Macon, GA; Department of Surgery (T.J.B.), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery (E.-C.C.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery (E.R.D.L.), Zuyderland Medical Center, Heerlen, the Netherlands; Department of Surgery (W.B.D., B.K.), Riverside Methodist Hospital, Columbus, Ohio; Department of Surgery (H.A.F.J.), OLVG Hospital, Amsterdam, the Netherlands; Division of Trauma Surgery, Department of Surgery (H.-J.K., Y.-H.S.), National Taiwan University Hospital, Hsinchu City, Taiwan; CJOB Department of Cardiothoracic Surgery (S.F.M., R.G.S.), The Alfred, Melbourne; Department of Surgery (S.F.M., R.G.S.), Monash University, Clayton, Victoria, Australia; Department of Surgery (W.R.S.), Isala Hospital; Department of Surgery (P.J.V.H.), Haga Hospital, The Hague; Department of Surgery (J.V.), Maasstad Hospital, Rotterdam; and Department of Surgery (D.I.V.), Amphia Hospital, Breda, the Netherlands., Van Lieshout EMM, Eriksson EA, Barnes M, Blokhuis TJ, Caragounis EC, Christie DB 3rd, De Loos ER, DeVoe WB, Formijne Jonkers HA, Kiel B, Ko HJ, Marasco SF, Spanjersberg WR, Su YH, Summerhayes RG, Van Huijstee PJ, Vermeulen J, Vos DI, Verhofstad MHJ, Wijffels MME
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2022 Dec 01; Vol. 93 (6), pp. 727-735. Date of Electronic Publication: 2022 Aug 24.
DOI:	10.1097/TA.0000000000003769
Abstrakt:	Background: The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR. Methods: An international, retrospective study was performed in patients who underwent SSRF or nonoperative management for multiple rib fractures following CPR between January 1, 2012, and July 31, 2020. Patients who underwent SSRF were matched to nonoperative controls by cardiac arrest location and cause, rib fracture pattern, and age. The primary outcome was ICU LOS. Results: Thirty-nine operatively treated patient were matched to 66 nonoperatively managed controls with comparable CPR-related characteristics. Patients who underwent SSRF more often had displaced rib fractures (n = 28 [72%] vs. n = 31 [47%]; p = 0.015) and a higher median number of displaced ribs (2 [P 25 -P 75 , 0-3] vs. 0 [P 25 -P 75 , 0-3]; p = 0.014). Surgical stabilization of rib fractures was performed at a median of 5 days (P 25 -P 75 , 3-8 days) after CPR. In the nonoperative group, a rib fixation specialist was consulted in 14 patients (21%). The ICU LOS was longer in the SSRF group (13 days [P 25 -P 75 , 9-23 days] vs. 9 days [P 25 -P 75 , 5-15 days]; p = 0.004). Mechanical ventilator-free days, hospital LOS, thoracic complications, and mortality were similar. Conclusion: Despite matching, those who underwent SSRF over nonoperative management for multiple rib fractures following CPR had more severe consequential chest wall injury and a longer ICU LOS. A benefit of SSRF on in-hospital outcomes could not be demonstrated. A low consultation rate for rib fixation in the nonoperative group indicates that the consideration to perform SSRF in this population might be associated with other nonradiographic or injury-related variables. Level of Evidence: Therapeutic/Care Management; Level III. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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