Surgical stabilization of rib fractures: The impact of volume and the need for standardized indications

Sai Krishna Bhogadi; Omar Hejazi; Adam Nelson; Collin Stewart; Hamidreza Hosseinpour; Audrey L Spencer; Tanya Anand; Michael Ditillo; Louis J Magnotti; Bellal Joseph

doi:10.1016/j.amjsurg.2024.03.019

Surgical stabilization of rib fractures: The impact of volume and the need for standardized indications

Am J Surg. 2024 Mar 26:S0002-9610(24)00180-6. doi: 10.1016/j.amjsurg.2024.03.019. Online ahead of print.

Authors

Affiliations

¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: saikbhogadi@arizona.edu.
² Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: ohejazi@arizona.edu.
³ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: adamcnelson@arizona.edu.
⁴ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: chstewart@surgery.arizona.edu.
⁵ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: Hosseinpourh@arizona.edu.
⁶ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: audreylspencer@arizona.edu.
⁷ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: tanyaanand@surgery.arizona.edu.
⁸ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: mfditillo@surgery.arizona.edu.
⁹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: lmagnotti@arizona.edu.
¹⁰ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@arizona.edu.

PMID: 38553337
DOI: 10.1016/j.amjsurg.2024.03.019

Abstract

Introduction: We aimed to examine impact of trauma center (TC) surgical stabilization of rib fracture (SSRF) volume on outcomes of patients undergoing SSRF.

Methods: Blunt rib fracture patients who underwent SSRF were included from ACS-TQIP2017-2021. TCs were stratified according to tertiles of SSRF volume:low (LV), middle, and high (HV). Outcomes were time to SSRF, respiratory complications, prolonged ventilator use, mortality.

Results: 16,872 patients were identified (LV:5470,HV:5836). Mean age was 56 years, 74% were male, median thorax-AIS was 3. HV centers had a lower proportion of patients with flail chest (HV41% vs LV50%), pulmonary contusion (HV44% vs LV52%) and had shorter time to SSRF(HV58 vs LV76 h), less respiratory complications (HV3.2% vs LV4.5%), prolonged ventilator use (HV15% vs LV26%), mortality (HV2% vs LV2.6%) (all p < 0.05). On multivariable regression analysis, HV centers were independently associated with reduced time to SSRF(β = -18.77,95%CI = -21.30to-16.25), respiratory complications (OR = 0.67,95%CI = 0.49-0.94), prolonged ventilator use (OR = 0.49,95%CI = 0.41-0.59), but not mortality.

Conclusions: HV SSRF centers have improved outcomes, however, there are variations in threshold for SSRF and indications must be standardized.

Level of evidence: Level III.

Study type: Therapeutic/Care Management.

Keywords: Rib fractures; Surgical stabilization; Thoracic trauma; Volume-outcome.