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Timing Matters: Early vs. Late Rib Fixation in Patients with Multiple Rib Fractures and Pulmonary Contusion
Emanuele Lagazzi MD
1,2, Wardah Rafaqat MBBS
1, Dias Argandykov MD
1, Amory de Roulet MD MPH
1, May Abiad MD
1, Jefferson A. Proaño-Zamudio MD
1, George C. Velmahos MD PhD
1, John O. Hwabejire MD MPH
1, Charudutt Paranjape MD MBBS
1, Katherine H. Albutt, MD MPH
1 1) Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
2) Department of Surgery, Humanitas Research Hospital, Rozzano, MI, Italy
Background: Recent literature has shown that surgical stabilization of rib fractures (SSRF) benefits patients with rib fractures accompanied by pulmonary contusion (PC), however, the impact of timing to SSRF in this patient population remains unexplored. We aimed to compare early vs. late SSRF in patients with traumatic rib fractures and concurrent PC.
Methods: We selected all adult patients with isolated blunt chest trauma, multiple rib fractures, and PC undergoing early (<72 hours) vs. late SSRF (≥72 hours) using the ACS-TQIP 2016-2020. Propensity score matching was performed to adjust for patient-, injury-, and hospital characteristics. Our outcomes were hospital length of stay (LOS), acute respiratory distress syndrome, unplanned intubation, ventilator days, unplanned ICU admission, ICU LOS, tracheostomy rates, and mortality. We then performed sub-group analyses for patients with major or minor PC.
Results: We included 2,839 patients, of whom 1,520 (53.5%) underwent early SSRF. Following propensity score matching, 1,096 well-balanced pairs were formed. Early SSRF was associated with a decrease in hospital LOS (9 vs. 13 days; p<0.001), decreased ICU LOS (5 vs. 7 days; p<0.001), and lower rates of unplanned intubation (7.4% vs. 11.4%; p=0.001), unplanned ICU admission (4.2% vs. 10.5%; p<0.001), and tracheostomy (8.4% vs. 12.4%; p=0.002). Similar results were also found in the subgroup analyses for patients with major or minor PC.
Conclusion: These findings suggest that in patients with multiple rib fractures and PC, the early implementation of SSRF could be beneficial regardless of the severity of PC.
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