When to proceed to surgical rib fixation?-A single-institution clinical experience.

Autor:	Belaroussi Y; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Drevet G; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Soldea V; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Patoir A; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Grima R; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Levrat A; Critical Care Unit, University Hospital of Annecy Genevois, Epagny Metz-Tessy, France., Rosamel P; Department of Anesthesia and Critical Care, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France., Tronc F; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.; Claude Bernard Lyon 1 University, Lyon, France., David JS; Claude Bernard Lyon 1 University, Lyon, France.; Department of Trauma and Emergency Surgery Unit, Department of Anesthesia and Critical Care, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France., Maury JM; Department of Thoracic Surgery, Lung and Heart Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.; Centre de l'innovation en cancérologie de Lyon, Lyon, France.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2023 Feb 28; Vol. 15 (2), pp. 323-334. Date of Electronic Publication: 2023 Feb 07.
DOI:	10.21037/jtd-22-735
Abstrakt:	Background: Surgical rib fixation for multiple rib fractures and flail chest has become more common in the 2000s with interesting results in selected patients. However, surgical rib fixation lacks a consensus on the delay to surgery and the benefits on postoperative clinical outcomes. Our goal was to determine if delay to surgery can affect postoperative outcomes. Methods: We analyzed a retrospective database including all consecutive patients referred for surgical rib fixation. All outcomes were explored according to trauma mechanism, associated lesions, initial ventilatory status, delay to surgery, surgical technique and a specific focus was made towards post-operative care and pulmonary complications. Logistic regressions were performed to evaluate the association between delay to surgery [before 48 hours (early group), 48 hours to 7 days (mid group), more than 7 days (late group)] and pneumonia and failure of extubating. Results: From 2010 to 2020, 159 patients underwent surgical rib fixation. The median hospital length of stay was 18 days (interquartile range, 13-30 days). Pulmonary infections were encountered in 67 patients (42.2%) with about two third of early pneumonia (<5 days). The one-month mortality rate was 1.9%. Delay to surgery was not associated with either pneumonia (P>0.05) or failure of extubating (P>0.05). Conclusions: Surgical rib fixation can be delayed without increasing the risk of pulmonary complications. Stabilizing other clinical situations can be safely prioritized if needed. A global evaluation including characteristics of trauma and lung evaluation must be considered before surgical stabilization of rib fracture. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-735/coif). GD reports personnal fees from Astra Zeneca for presentations. JSD reports honoraria for lectures and expertise from LFB Laboratory, les Ullis, France outside the submitted work. The other authors have no conflicts of interest to declare. (2023 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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