Late Operative Rib Fixation is Inferior to Nonoperative Management
Background Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experienc...
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| Veröffentlicht in: | The American surgeon 2020-08, Vol.86 (8), p.944-949 |
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| creator | Harrell, Kevin N. Jean, Robert J. Dave Bhattacharya, S. Hunt, Darren J. Barker, Donald E. Maxwell, Robert A. |
| description | Background
Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center.
Methods
ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls.
Results
Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days.
Discussion
Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma. |
| doi_str_mv | 10.1177/0003134820942185 |
| format | Article |
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Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center.
Methods
ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls.
Results
Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days.
Discussion
Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/0003134820942185</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Chest ; Chest tubes ; Clinical outcomes ; Fixation ; Fractures ; Hospitalization ; Injuries ; Intensive care ; Medical records ; Mortality ; Ostomy ; Pain ; Patients ; Pneumonia ; Pulmonary functions ; Respiratory function ; Rib ; Rib cage ; Ribs ; Statistical analysis ; Tracheotomy ; Trauma ; Ventilators</subject><ispartof>The American surgeon, 2020-08, Vol.86 (8), p.944-949</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c342t-eb68d7724122d39af258e2034a0ce38bffc55ff2e7cc1c2b2399ebac2306b483</citedby><cites>FETCH-LOGICAL-c342t-eb68d7724122d39af258e2034a0ce38bffc55ff2e7cc1c2b2399ebac2306b483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0003134820942185$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0003134820942185$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,778,782,21806,27911,27912,43608,43609</link.rule.ids></links><search><creatorcontrib>Harrell, Kevin N.</creatorcontrib><creatorcontrib>Jean, Robert J.</creatorcontrib><creatorcontrib>Dave Bhattacharya, S.</creatorcontrib><creatorcontrib>Hunt, Darren J.</creatorcontrib><creatorcontrib>Barker, Donald E.</creatorcontrib><creatorcontrib>Maxwell, Robert A.</creatorcontrib><title>Late Operative Rib Fixation is Inferior to Nonoperative Management</title><title>The American surgeon</title><description>Background
Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center.
Methods
ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls.
Results
Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days.
Discussion
Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma.</description><subject>Chest</subject><subject>Chest tubes</subject><subject>Clinical outcomes</subject><subject>Fixation</subject><subject>Fractures</subject><subject>Hospitalization</subject><subject>Injuries</subject><subject>Intensive care</subject><subject>Medical records</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Pain</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Pulmonary functions</subject><subject>Respiratory function</subject><subject>Rib</subject><subject>Rib cage</subject><subject>Ribs</subject><subject>Statistical analysis</subject><subject>Tracheotomy</subject><subject>Trauma</subject><subject>Ventilators</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kM1LAzEQxYMoWKt3jwEvXlbzuUmOWqwWqgXpfcmmE0lpNzXZiv73plQUCp6Gx_u9x8wgdEnJDaVK3RJCOOVCM2IEo1oeoQGVUlZGM36MBju72vmn6CznZZGilnSA7qe2BzzbQLJ9-AD8Glo8Dp9FxA6HjCedhxRiwn3EL7GLv-Cz7ewbrKHrz9GJt6sMFz9ziObjh_noqZrOHieju2nluGB9BW2tF0oxQRlbcGM9kxoY4cISB1y33jspvWegnKOOtYwbA611jJO6FZoP0fW-dpPi-xZy36xDdrBa2Q7iNjdMcCWI0HVd0KsDdBm3qSvLFUooTYUyplBkT7kUc07gm00Ka5u-Gkqa3U-bw5-WSLWP5HL7X-m__DcjcHSi</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Harrell, Kevin N.</creator><creator>Jean, Robert J.</creator><creator>Dave Bhattacharya, S.</creator><creator>Hunt, Darren J.</creator><creator>Barker, Donald E.</creator><creator>Maxwell, Robert A.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>202008</creationdate><title>Late Operative Rib Fixation is Inferior to Nonoperative Management</title><author>Harrell, Kevin N. ; Jean, Robert J. ; Dave Bhattacharya, S. ; Hunt, Darren J. ; Barker, Donald E. ; Maxwell, Robert A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c342t-eb68d7724122d39af258e2034a0ce38bffc55ff2e7cc1c2b2399ebac2306b483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Chest</topic><topic>Chest tubes</topic><topic>Clinical outcomes</topic><topic>Fixation</topic><topic>Fractures</topic><topic>Hospitalization</topic><topic>Injuries</topic><topic>Intensive care</topic><topic>Medical records</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Pain</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Pulmonary functions</topic><topic>Respiratory function</topic><topic>Rib</topic><topic>Rib cage</topic><topic>Ribs</topic><topic>Statistical analysis</topic><topic>Tracheotomy</topic><topic>Trauma</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harrell, Kevin N.</creatorcontrib><creatorcontrib>Jean, Robert J.</creatorcontrib><creatorcontrib>Dave Bhattacharya, S.</creatorcontrib><creatorcontrib>Hunt, Darren J.</creatorcontrib><creatorcontrib>Barker, Donald E.</creatorcontrib><creatorcontrib>Maxwell, Robert A.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harrell, Kevin N.</au><au>Jean, Robert J.</au><au>Dave Bhattacharya, S.</au><au>Hunt, Darren J.</au><au>Barker, Donald E.</au><au>Maxwell, Robert A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late Operative Rib Fixation is Inferior to Nonoperative Management</atitle><jtitle>The American surgeon</jtitle><date>2020-08</date><risdate>2020</risdate><volume>86</volume><issue>8</issue><spage>944</spage><epage>949</epage><pages>944-949</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center.
Methods
ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls.
Results
Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days.
Discussion
Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><doi>10.1177/0003134820942185</doi><tpages>6</tpages></addata></record> |
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| source | SAGE Complete A-Z List |
| subjects | Chest Chest tubes Clinical outcomes Fixation Fractures Hospitalization Injuries Intensive care Medical records Mortality Ostomy Pain Patients Pneumonia Pulmonary functions Respiratory function Rib Rib cage Ribs Statistical analysis Tracheotomy Trauma Ventilators |
| title | Late Operative Rib Fixation is Inferior to Nonoperative Management |
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