Erik A Green1, Chrissy Guidry2, Charles Harris3, Patrick McGrew2, Rebecca Schroll4, Mohammad Hussein2, Eman Toraih2, Jay Kolls5, Juan Duchesne2, Sharven Taghavi6. 1. Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: egreen9@tulane.edu. 2. Department of Surgery, Tulane University School of Medicine, New Orleans, LA. 3. Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: https://twitter.com/CharlieTHarris. 4. Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: https://twitter.com/BeccaSchroll. 5. Center for Translational Research in Infection and Inflammation, Tulane University School of Medicine, New Orleans, LA. Electronic address: https://twitter.com/gotTcells? 6. Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: https://twitter.com/STaghaviMD.
Abstract
BACKGROUND: Surgical stabilization for rib fractures (SSRF) in trauma patients remains controversial, with guidelines currently suggesting the procedure for only select patient groups. How surgical stabilization for rib fractures affect hospital readmission in patients with traumatic rib fractures is unknown. We hypothesized that surgical stabilization for rib fractures would not decrease the risk of readmission. METHODS: The National Readmission Database was examined for adults with any rib fractures from 2010 to 2017. Readmission up to 90 days was examined. Patients receiving surgical stabilization for rib fractures were compared with those receiving nonoperative treatment. RESULTS: In total, 864,485 patients met criteria, with 13,701 (1.6%) receiving SSRF. For patients receiving SSRF, 338 (1.5%) were readmitted. Readmitted patients had higher Charlson Comorbidity Index and were more likely to have flail chest. On multivariate propensity score-matched analysis, SSRF (Hazard Ratio [HR]: 0.55, 95% confidence interval [CI] 0.33-0.92, P = .022) was associated with reduced readmission. Addition of surgical stabilization for rib fractures to video-assisted thoracoscopic surgery (VATS) (Odds Ratio [OR]: 0.95, 95% CI 0.52-1.73, P = .86) or thoracotomy (OR: 1.97, 95% CI 0.83-4.70, P = .13) was not associated with increased readmission. On further propensity matched analysis, VATS + SSRF when compared with SSRF alone (HR: 0.75, 95% CI 0.18-3.20, P = .696), and VATS + SSRF when compared with VATS alone (HR: 0.49, 95% CI 0.11-2.22, P = .355) was also not associated with increased readmission. SSRF on primary admission was associated with increased in-hospital survival (HR: 0.27, 95% CI 0.22-0.32, P < .001). For patients with retained hemothorax who underwent VATS, addition of SSRF did not improve survival (HR = 0.92, 95% CI 0.58-1.46, P = .72). However, for patients requiring thoracotomy for retained hemothorax, concomitant SSRF was associated with improved survival (HR = 0.14, 95% CI 0.06-0.32, P < .001). CONCLUSION: Surgical stabilization for rib fractures is associated with reduced readmission risk while also being associated with improved survival. Patients who had a thoracotomy for retained hemothorax appear to especially benefit from concomitant surgical stabilization for rib fractures.
BACKGROUND: Surgical stabilization for rib fractures (SSRF) in trauma patients remains controversial, with guidelines currently suggesting the procedure for only select patient groups. How surgical stabilization for rib fractures affect hospital readmission in patients with traumatic rib fractures is unknown. We hypothesized that surgical stabilization for rib fractures would not decrease the risk of readmission. METHODS: The National Readmission Database was examined for adults with any rib fractures from 2010 to 2017. Readmission up to 90 days was examined. Patients receiving surgical stabilization for rib fractures were compared with those receiving nonoperative treatment. RESULTS: In total, 864,485 patients met criteria, with 13,701 (1.6%) receiving SSRF. For patients receiving SSRF, 338 (1.5%) were readmitted. Readmitted patients had higher Charlson Comorbidity Index and were more likely to have flail chest. On multivariate propensity score-matched analysis, SSRF (Hazard Ratio [HR]: 0.55, 95% confidence interval [CI] 0.33-0.92, P = .022) was associated with reduced readmission. Addition of surgical stabilization for rib fractures to video-assisted thoracoscopic surgery (VATS) (Odds Ratio [OR]: 0.95, 95% CI 0.52-1.73, P = .86) or thoracotomy (OR: 1.97, 95% CI 0.83-4.70, P = .13) was not associated with increased readmission. On further propensity matched analysis, VATS + SSRF when compared with SSRF alone (HR: 0.75, 95% CI 0.18-3.20, P = .696), and VATS + SSRF when compared with VATS alone (HR: 0.49, 95% CI 0.11-2.22, P = .355) was also not associated with increased readmission. SSRF on primary admission was associated with increased in-hospital survival (HR: 0.27, 95% CI 0.22-0.32, P < .001). For patients with retained hemothorax who underwent VATS, addition of SSRF did not improve survival (HR = 0.92, 95% CI 0.58-1.46, P = .72). However, for patients requiring thoracotomy for retained hemothorax, concomitant SSRF was associated with improved survival (HR = 0.14, 95% CI 0.06-0.32, P < .001). CONCLUSION: Surgical stabilization for rib fractures is associated with reduced readmission risk while also being associated with improved survival. Patients who had a thoracotomy for retained hemothorax appear to especially benefit from concomitant surgical stabilization for rib fractures.
Authors: Jonne T H Prins; Esther M M Van Lieshout; Francis Ali-Osman; Zachary M Bauman; Eva-Corina Caragounis; Jeff Choi; D Benjamin Christie; Peter A Cole; William B DeVoe; Andrew R Doben; Evert A Eriksson; Joseph D Forrester; Douglas R Fraser; Brendan Gontarz; Claire Hardman; Daniel G Hyatt; Adam J Kaye; Huan-Jang Ko; Kiara N Leasia; Stuart Leon; Silvana F Marasco; Allison G McNickle; Timothy Nowack; Temi D Ogunleye; Prakash Priya; Aaron P Richman; Victoria Schlanser; Gregory R Semon; Ying-Hao Su; Michael H J Verhofstad; Julie Whitis; Fredric M Pieracci; Mathieu M E Wijffels Journal: Eur J Trauma Emerg Surg Date: 2022-02-22 Impact factor: 2.374