Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study
Hoepelman, Ruben J.; Beeres, Frank J. P.; Beks, Reinier B.; Sweet, Arthur A. R.; Ijpma, Frank F.; Lansink, Koen W. W.; van Wageningen, Bas; Tromp, Tjarda N.; Link, Bjoern-Christian; van Veelen, Nicole M.; Hoogendoorn, Jochem M.; de Jong, Mirjam B.; van Baal, Mark C. P.; Leenen, Luke P. H.; Groenwold; Houwert, Roderick M.
(2023) European Journal of Trauma and Emergency Surgery, volume 49, issue 1, pp. 461 - 471
(Article)
Abstract
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
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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. Trial registration: Registered in the Netherlands Trial Register NTR6833 on 13/11/2017.
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Keywords: Multiple rib fractures, Non-operative treatment, Rib fixation, Rib fracture, Critical Care and Intensive Care Medicine, Surgery, Emergency Medicine, Orthopedics and Sports Medicine
ISSN: 1863-9933
Publisher: Urban und Vogel
Note: Funding Information: This work was financially supported by the DePuy Synthes (grant number DPS-TCMF-2017-036). The organization was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All researchers are independent from the funder. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: This work was part of the activities of the Natural Experiments Study Group (www.next-studygroup.org). Publisher Copyright: © 2022, The Author(s).
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