Ruben J Hoepelman1,2, Frank J P Beeres2,3, Marilyn Heng4, Matthias Knobe2, Björn-Christian Link2, Fabrizio Minervini2, Reto Babst2,3, Roderick M Houwert1, Bryan J M van de Wall5,6. 1. Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, 6000, Lucerne, Switzerland. 3. Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. 4. Department of Orthopedic Surgery, Orthopedic Trauma Initiative, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, 6000, Lucerne, Switzerland. Bryan.vandewall@luks.ch. 6. Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. Bryan.vandewall@luks.ch.
Abstract
BACKGROUND: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates. METHODS: Multiple databases were searched for comparative studies reporting on conservative versus operative treatment for rib fractures in patients older than 60 years. Both observational studies and randomised clinical trials were considered. RESULTS: Five observational studies (n = 2583) were included. Mortality was lower in operatively treated patients compared to conservative treatment (4% vs. 8%). Pneumonia rate and DMV were similar (5/6% and 5.8/6.5 days) for either treatment modality. Overall ILOS and HLOS of stay were longer in operatively treated patients (6.5 ILOS and 12.7 HLOS vs. 2.7 ILOS and 6.5 ILOS). There were only minimal reports on perioperative complications. Notably, the median number of rib fractures (8.4 vs. 5) and the percentage of flail chest were higher in operatively treated patients (47% vs. 39%). CONCLUSION: It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient's outcome.
BACKGROUND: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates. METHODS: Multiple databases were searched for comparative studies reporting on conservative versus operative treatment for rib fractures in patients older than 60 years. Both observational studies and randomised clinical trials were considered. RESULTS: Five observational studies (n = 2583) were included. Mortality was lower in operatively treated patients compared to conservative treatment (4% vs. 8%). Pneumonia rate and DMV were similar (5/6% and 5.8/6.5 days) for either treatment modality. Overall ILOS and HLOS of stay were longer in operatively treated patients (6.5 ILOS and 12.7 HLOS vs. 2.7 ILOS and 6.5 ILOS). There were only minimal reports on perioperative complications. Notably, the median number of rib fractures (8.4 vs. 5) and the percentage of flail chest were higher in operatively treated patients (47% vs. 39%). CONCLUSION: It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient's outcome.
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Authors: Reinier B Beks; Jesse Peek; Mirjam B de Jong; Karlijn J P Wessem; Cumhur F Öner; Falco Hietbrink; Luke P H Leenen; Rolf H H Groenwold; Roderick M Houwert Journal: Eur J Trauma Emerg Surg Date: 2018-10-01 Impact factor: 3.693
Authors: Ruben J Hoepelman; Frank J P Beeres; Reinier B Beks; Arthur A R Sweet; Frank F Ijpma; Koen W W Lansink; Bas van Wageningen; Tjarda N Tromp; Björn-Christian Link; Nicole M van Veelen; Jochem M Hoogendoorn; Mirjam B de Jong; Mark C P van Baal; Luke P H Leenen; Rolf H H Groenwold; Roderick M Houwert Journal: Eur J Trauma Emerg Surg Date: 2022-08-25 Impact factor: 2.374