J. Laredo1, K. Lange2, A. Cavalea2, J. Griepentrog2 1University of Tennessee Health Science Center, Memphis, TN, USA 2University of Tennessee Medical Center, Knoxville, TN, USA
Introduction: Surgical stabilization of rib fractures is increasingly utilized to treat patients with chest wall instability. In this population, rib fixation is associated with decreased ICU and total hospital length of stay, in addition to shorter time spent on mechanical ventilation and lower rates of mortality. However, the clinical impact of other variables on the outcomes of these patients, such as concomitant pulmonary trauma and time to rib fixation, is widely understudied with the potential to improve current guidelines and treatment protocols.
Methods: All patients who underwent surgical stabilization of multiple rib fractures between January 1, 2017 and June 30, 2023 at the University of Tennessee Medical Center in Knoxville were identified. Demographic and outcomes data, including patient age, gender, BMI, total hospital LOS, ICU LOS, ventilator days, and final disposition, were obtained from the trauma registry. Information related to the patient’s operation and hospital course, such as admission to surgery time, operative time, major hospital events, and injury diagnoses, were gathered using chart review. Relevant co-morbidities were also noted. Standard two-sample T-tests and linear regression analyses were performed to determine statistical significance.
Results: Increased time to rib fixation correlated with prolonged ICU LOS (R2 = 0.14, SE = 6.03, p < 0.0003) and time on a mechanical ventilator (R2 = 0.10, SE = 5.80, p < 0.002). The total number of rib fractures was also found to correlate with increased ICU LOS (R2 = 0.09, SE = 6.21, p < 0.004) and ventilator days (R2 = 0.08, SE = 5.89, p < 0.006). Patients with bilateral rib fractures were found to have longer ICU LOS (p < 0.0001) and ventilator times (p < 0.0001) than those with unilateral fractures, regardless of total fracture number. COPD was associated with longer ICU LOS (p = 0.013) and ventilator days (p = 0.023), while BMI was found to have no association with any of the measured outcomes.
Conclusion: The timing of surgical stabilization of rib fractures correlates positively with time spent under intensive care and is an important variable to consider when managing trauma patients. Interestingly, clinical outcomes following this procedure did not correlate with BMI in our population, an observation that deviates from trends seen with other types of surgeries. Future clinical trials should examine the optimal timing of rib fixation in order to standardize the pre-operative management of these patients.