"Early results after initiation of a rib fixation programme: A propensity score matched analysis"

Grace Niziolek; Michael D Goodman; Amy Makley; D Anderson Millar; Victor Heh; Timothy A Pritts; Christopher Janowak

doi:10.1016/j.injury.2021.09.009

"Early results after initiation of a rib fixation programme: A propensity score matched analysis"

Injury. 2022 Jan;53(1):137-144. doi: 10.1016/j.injury.2021.09.009. Epub 2021 Sep 17.

Authors

Grace Niziolek¹, Michael D Goodman², Amy Makley³, D Anderson Millar⁴, Victor Heh⁵, Timothy A Pritts⁶, Christopher Janowak⁷

Affiliations

¹ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: martigc@ucmail.uc.edu.
² Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: goodmamd@ucmail.uc.edu.
³ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: makleyat@ucmail.uc.edu.
⁴ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: millardn@ucmail.uc.edu.
⁵ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: hehvr@ucmail.uc.edu.
⁶ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: prittsta@ucmail.uc.edu.
⁷ Divisions of UCMC and WCH Trauma, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Electronic address: christopher.janowak@uc.edu.

PMID: 34565619
DOI: 10.1016/j.injury.2021.09.009

Abstract

Introduction: Chest wall injuries are very common in blunt trauma and development of treatment protocols can significantly improve outcomes. Surgical stabilisation of rib fractures (SSRF) is an adjunct for the most severe chest injuries and can be used as a part of a comprehensive approach to chest injuries care. We hypothesized that implementation of a SSRF programme program would result in improved short-term outcomes.

Materials and methods: The characteristics of the initial group of SSRF patients (Early-SSRF) were used to identify matching factors. Patients prior to SSRF protocol underwent a propensity score match, followed by screening for operative indications and contraindications. After exclusions, a non-operative (Non-Op) cohort was defined (n=36) resulting in an approximately 1:1 match. An overall operative cohort, inclusive of Early-SSRF and all subsequent operative patients, was defined (All- SSRF). A before-and-after analysis using chi-squared, Students T-tests, and Mann-Whitney U-tests were used to assess significance at the level of 0.05.

Results: Early-SSRF (n=22) and All-SSRF (n=45) were compared to Non-Op (n=36). The selection process resulted in well matched groups, and equally well-balanced operative indications between the groups. The Early-SSRF group demonstrated shortened duration of mechanical ventilation and a decreased frequency of being discharged a long-term acute care hospital. The All-SSRF group again demonstrated markedly shorter duration of mechanical ventilation compared to Non-Op (median 6 days vs 16 days, p < 0.01), more decrease discharge to a long-term acute care hospital (9% vs. 36%, p=0.01), and reduced risk for tracheostomy (8.9% vs. 33.3% respectively, p<0.01) CONCLUSION: The introduction of an operative rib fixation to a comprehensive chest wall injury protocol can produce improvements in clinical outcomes that decrease time on the ventilator and tracheostomy rates, and result in more patients being discharged to home. Creation and implementation of a chest wall injury protocol to include SSRF requires a multidisciplinary approach and thoughtful patient selection.

Keywords: Outcomes; Rib Fixation; Rib fracture; SSRF; Thoracic trauma.

MeSH terms

Humans
Length of Stay
Propensity Score
Retrospective Studies
Rib Fractures* / surgery
Ribs
Thoracic Injuries*