Impact of Time of Surgery on the Outcome After Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma-A Matched-Pairs Analysis of the German Trauma Registry

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Jun 1

PMID 35647014

Authors

L Becker

S Schulz-Drost

C Spering

A Franke

M Dudda

O Kamp

R Lefering

G Matthes

D Bieler

Affiliations

Soon will be listed here.

Abstract

Purpose: In severely injured patients with multiple rib fractures, the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results, and the indication and especially the right timing of an operation are the subject of a broad discussion. The aim of this study was to determine the influence of the time point of surgical stabilization of rib fractures (SSRF) on the outcome in a multicenter database with special regard to the duration of ventilation, intensive care, and overall hospital stay.

Methods: Data from the TraumaRegister DGU collected between 2010 and 2019 were used to evaluate patients above 16 years of age with severe rib fractures [Abbreviated Injury Score (AIS) ≥ 3] who received an SSRF in a matched-pairs analysis. In this matched-pairs analysis, we compared the effects of an early SSRF within 48 h after initial trauma vs. late SSRF 3-10 days after trauma.

Results: After the selection process, we were able to find 142 matched pairs for further evaluation. Early SSRF was associated with a significantly shorter length of stay in the intensive care unit (16.2 days vs. 12.7 days, = 0.020), and the overall hospital stay (28.5 days vs. 23.4 days, = 0.005) was significantly longer in the group with late SSRF. Concerning the days on mechanical ventilation, we were able to demonstrate a trend for an approximately 1.5 day shorter ventilation time for patients after early SSRF, although this difference was not statistically significant ( = 0.226).

Conclusions: We were able to determine the significant beneficial effects of early SSRF resulting in a shorter intensive care unit stay and a shorter length of stay in hospital and additionally a trend to a shorter time on mechanical ventilation.

Citing Articles

Surgical stabilisation of rib fractures in non-ventilated patients: a retrospective propensity-matched analysis using the data from the trauma registry of the German Trauma Society (TraumaRegister DGU).

Huelskamp M, Duesing H, Lefering R, Raschke M, Rosslenbroich S Eur J Trauma Emerg Surg. 2025; 51(1):55.

PMID: 39856261 PMC: 11761477. DOI: 10.1007/s00068-024-02756-9.

Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.

Sermonesi G, Bertelli R, Pieracci F, Balogh Z, Coimbra R, Galante J World J Emerg Surg. 2024; 19(1):33.

PMID: 39425134 PMC: 11487890. DOI: 10.1186/s13017-024-00559-2.

Time to surgical stabilization of rib fractures: does it impact outcomes?.

Forrester J, Sarani B, Forssten M, Cao Y, Hildebrand F, Mohammad Ismail A Trauma Surg Acute Care Open. 2024; 9(1):e001233.

PMID: 39005708 PMC: 11243129. DOI: 10.1136/tsaco-2023-001233.

[Complications after conservative vs. operative treatment of severe thoracic trauma].

Becker L, Dudda M, Schreyer C Unfallchirurgie (Heidelb). 2024; 127(3):204-210.

PMID: 38285188 DOI: 10.1007/s00113-024-01411-7.

[Surgical reconstruction of chest wall instability : Indications, contraindications and timing of surgery].

Spering C, Moerer O, White T, Lehmann W Unfallchirurgie (Heidelb). 2024; 127(3):171-179.

PMID: 38214732 DOI: 10.1007/s00113-023-01400-2.

References

Leinicke J, Elmore L, Freeman B, Colditz G . Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013; 258(6):914-21. PMC: 3694995. DOI: 10.1097/SLA.0b013e3182895bb0. View

Schuurmans J, Goslings J, Schepers T . Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2016; 43(2):163-168. PMC: 5378742. DOI: 10.1007/s00068-016-0721-2. View

Gerakopoulos E, Walker L, Melling D, Scott S, Scott S . Surgical Management of Multiple Rib Fractures Reduces the Hospital Length of Stay and the Mortality Rate in Major Trauma Patients: A Comparative Study in a UK Major Trauma Center. J Orthop Trauma. 2018; 33(1):9-14. DOI: 10.1097/BOT.0000000000001264. View

Pieracci F, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards J . Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2016; 48(2):307-321. DOI: 10.1016/j.injury.2016.11.026. View

de Moya M, Bramos T, Agarwal S, Fikry K, Janjua S, King D . Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma. 2011; 71(6):1750-4. DOI: 10.1097/TA.0b013e31823c85e9. View

Green E, Guidry C, Harris C, McGrew P, Schroll R, Hussein M . Surgical stabilization of traumatic rib fractures is associated with reduced readmissions and increased survival. Surgery. 2021; 170(6):1838-1848. DOI: 10.1016/j.surg.2021.05.032. View

Copes W, Champion H, Sacco W, Lawnick M, Keast S, Bain L . The Injury Severity Score revisited. J Trauma. 1988; 28(1):69-77. DOI: 10.1097/00005373-198801000-00010. View

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B . Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II. Crit Care. 2014; 18(5):476. PMC: 4177428. DOI: 10.1186/s13054-014-0476-2. View

DeFreest L, Tafen M, Bhakta A, Ata A, Martone S, Glotzer O . Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg. 2016; 211(4):761-7. DOI: 10.1016/j.amjsurg.2015.11.014. View

10.

Pieracci F, Lin Y, Rodil M, Synder M, Herbert B, Tran D . A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2015; 80(2):187-94. DOI: 10.1097/TA.0000000000000925. View

11.

Otaka S, Aso S, Matsui H, Fushimi K, Yasunaga H . Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study. Eur J Trauma Emerg Surg. 2020; 48(2):1501-1508. PMC: 7673683. DOI: 10.1007/s00068-020-01548-1. View

12.

Iqbal H, Alsousou J, Shah S, Jayatilaka L, Scott S, Scott S . Early Surgical Stabilization of Complex Chest Wall Injuries Improves Short-Term Patient Outcomes. J Bone Joint Surg Am. 2018; 100(15):1298-1308. DOI: 10.2106/JBJS.17.01215. View

13.

Majak P, Naess P . Rib fractures in trauma patients: does operative fixation improve outcome?. Curr Opin Crit Care. 2016; 22(6):572-577. DOI: 10.1097/MCC.0000000000000364. View

14.

Cataneo A, Cataneo D, de Oliveira F, Arruda K, El Dib R, de Oliveira Carvalho P . Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev. 2015; (7):CD009919. PMC: 9189492. DOI: 10.1002/14651858.CD009919.pub2. View

15.

Haasper C, Junge M, Ernstberger A, Brehme H, Hannawald L, Langer C . [The Abbreviated Injury Scale (AIS). Options and problems in application]. Unfallchirurg. 2010; 113(5):366-72. DOI: 10.1007/s00113-010-1778-8. View

16.

Marasco S, Martin K, Niggemeyer L, Summerhayes R, Fitzgerald M, Bailey M . Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury. 2018; 50(1):119-124. DOI: 10.1016/j.injury.2018.11.005. View

17.

Beks R, Peek J, de Jong M, Wessem K, Oner C, Hietbrink F . Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2018; 45(4):631-644. PMC: 6689030. DOI: 10.1007/s00068-018-1020-x. View

18.

Baker S, ONeill B, HADDON Jr W, Long W . The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3):187-96. View

19.

Swart E, Laratta J, Slobogean G, Mehta S . Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis. J Orthop Trauma. 2016; 31(2):64-70. DOI: 10.1097/BOT.0000000000000750. View

20.

Otaka S, Aso S, Matsui H, Fushimi K, Yasunaga H . Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study. Ann Thorac Surg. 2020; 110(3):988-992. DOI: 10.1016/j.athoracsur.2020.03.084. View