TY - JOUR
T1 - Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma
T2 - a multicenter prospective cohort study
AU - Hoepelman, Ruben J.
AU - Beeres, Frank J. P.
AU - Beks, Reinier B.
AU - Sweet, Arthur A. R.
AU - Ijpma, Frank F.
AU - Lansink, Koen W. W.
AU - van Wageningen, Bas
AU - Tromp, Tjarda N.
AU - Link, Bjoern-Christian
AU - van Veelen, Nicole M.
AU - Hoogendoorn, Jochem M.
AU - de Jong, Mirjam B.
AU - van Baal, Mark C. P.
AU - Leenen, Luke P. H.
AU - Groenwold, Rolf H. H.
AU - Houwert, Roderick M.
PY - 2023/2
Y1 - 2023/2
N2 - Background Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking. Methods We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching. Results In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8-9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI - 0.2-0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation. Conclusions We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures.
AB - Background Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking. Methods We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching. Results In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8-9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI - 0.2-0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation. Conclusions We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures.
KW - Rib fixation
KW - Multiple rib fractures
KW - Rib fracture
KW - Non-operative treatment
KW - SURGICAL STABILIZATION
KW - STATEMENT
KW - CENTERS
U2 - 10.1007/s00068-022-02093-9
DO - 10.1007/s00068-022-02093-9
M3 - Article
SN - 1863-9933
VL - 49
SP - 461
EP - 471
JO - European Journal of Trauma and Emergency Surgery
JF - European Journal of Trauma and Emergency Surgery
ER -