Surgical stabilization of rib fractures in anticoagulated patients: Proceed with caution?

Autor: van Diepen MR; Trauma Research Unit Department of surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States. Electronic address: m.vandiepen@erasmusmc.nl., van Wijck SFM; Trauma Research Unit Department of surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States., Vittetoe E; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States., Sauaia A; Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, United States., Wijffels MME; Trauma Research Unit Department of surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Pieracci FM; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado, United States.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Sep; Vol. 55 (9), pp. 111708. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1016/j.injury.2024.111708
Abstrakt: Background: Surgical stabilization of rib fractures (SSRF) is increasingly performed, however the outcome of patients undergoing SSRF while on pre-injury antithrombotic therapy remains unknown. We compared surgical variables and outcomes of patients who were and were not on antithrombotic therapy. We hypothesize pre-injury anticoagulation is associated with delay in SSRF and worse outcomes.
Methods: For this retrospective cohort study, we queried the Chest Injury International Database, for patients undergoing SSRF between 08/2018 and 03/2022. Antithrombotic therapy was categorized into antiplatelet and anticoagulant use. Primary outcome was time from admission to SSRF. Secondary outcomes included SSRF duration and complications. Numerical data were presented as median (IQR), categorical data as number (%). Inverse probability weighting was used to control for confounding.
Results: Two hundred and eighteen SSRF patients were included, 25 (11 %) were on antithrombotic therapy. These patients were older (72 years, (65-80) versus 57 years, (43-66); p < 0.001) with lower ISS (14, (10-20) versus 21, (14-30); p = 0.002). Time from admission to SSRF was comparable (2 days, (1-4) versus 2 days, (1-4); p = 0.37) as was operative time (154 mins, (120.0-212.0) versus 177 mins, (143.0-210.0); p = 0.34). Patients using antithrombotics had fewer ICU-free days (24 (22-26) versus 28 (23-28); p = 0.003) but more ventilator free days (28, (28-28) versus 27 (27-28); p < 0.008). After adjusting for confounding, pre-injury anticoagulation was not significantly associated with delayed SSRF (Relative Risk, RR=1.37, 95 % CI 0.30-6.24), operative time (RR=1.07, 95 % CI0.88-1.31), IFD <=28 (RR=2.05, 95 %CI:0.33-12.67), VFD<=27 (RR=0.71, 95 %CI:0.15-3.48) or complications (RR=0.55, 95 % CI0.06-5.01).
Conclusion: Pre-injury antithrombotic drug use neither delayed SSRF nor impacted operative time in patients requiring SSRF and was not associated with increased risk of complications. Our data suggest SSRF can be safely performed without delay in patients who use anticoagulation pre-injury.
Level of Evidence: IV.
Study Type: Therapeutic/care management.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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