Rib fractures (RF) are common injuries, seen in up to 10% of all injured patients, and are particularly common in patients with blunt chest trauma.
Surgical stabilization for rib fractures (SSRF) in trauma patients remains controversial, and guidelines currently suggest the procedure only for selected groups. It is unknown how surgical stabilization of rib fractures affects hospital readmission in patients with these types of injuries.
The objective of this study was to examine how SSRF affects survival and hospital readmissions in patients with rib fractures, looking especially at patients requiring thoracic surgery with retained hemothorax. We hypothesized that rib plating would not decrease the risk of readmission.
| Materials and methods |
The national readmission database was examined for adults with rib fractures between 2010 and 2017. Readmission was examined up to 90 days. Patients who received surgical stabilization for rib fractures were compared with those who received conservative treatment.
| Results |
In total, 864,485 patients met the criteria and 13,701 (1.6%) underwent SSRF surgery.
In the comparison between patients undergoing SSRF and those treated without surgery, the former were significantly younger, less likely to have a single rib fracture (9.1% vs. 25.4%) or multiple RFs (65.8%). % vs. 72.8%), had lower proportions of comorbidities, and were more likely to have undergone video-assisted thoracic surgery (VATS) (7.2% vs. 1%) and thoracotomy (2.5% vs. 0.3%).
Patients with SSRF had higher survival rates. However, they had a longer hospital stay, were more likely to require mechanical ventilation, and were more likely to have complications.
Consequently, both hospital charge and costs were higher for the SSRF group. SSRF patients were more likely to receive treatment at large, metropolitan non-teaching hospitals, and at public or private nonprofit hospitals.
For patients who received SSRF, 338 (1.5%) were readmitted. This small group had a higher comorbidity rate and was more likely to have a flail chest.
| Discussion |
Although SSRF in traumatic RF remains controversial, its use is growing because there is broader acceptance of the procedure. Despite this, indications and outcomes remain poorly defined.
As expected, factors found to be generally associated with readmission included increasing age, discharge to a short-term care hospital, and withdrawal against medical advice. SSRF was found not to be associated with readmission when looking at all patients with RF. When looking at patients who had multiple RFs or flail chest, there was a reduced risk of readmission compared to a similar group of patients treated nonoperatively.
The study also showed an association between SSRF and an improvement in overall survival of patients treated with SSRF compared to those treated without surgery. This is in accordance with other recent studies, which also show an overall survival benefit for SSRF.
Although this mortality benefit may provide a reason to expand the use of SSRF, this study may reflect the higher proportion of patients with flail chest treated with this intervention.
The present work also showed that patients with SSRF had longer hospital costs. This contrasts with other published studies and meta-analyses, which have demonstrated improvements in this aspect.
| Conclusions |
- Surgical stabilization of rib fractures is associated with a lower risk of readmission and also better survival.
- Patients who underwent thoracotomy for retained hemothorax appear to benefit especially from concomitant surgical stabilization for rib fractures.
