S.K. Mathai1, M.R. Bronsert2, D.M. Garofalo1, C.M. Stuart1, A.R. Dyas1, Q.W. Myers1, L.T. Gallagher1, A. Wolf1, C. Heron1, P.D. Rozeboom1, R.A. Meguid1, C.G. Velopulos1 1University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA 2University Of Colorado Denver, Colorado Health Outcomes Center, Aurora, CO, USA
Introduction: The role of surgical stabilization of rib fractures (SSRF) remains controversial despite literature demonstrating an improvement in pneumonia, duration of ventilation, intensive care and hospitalization when compared to non-operative management. Current guidelines recommend early SSRF; however, the adoption and effectiveness of these guidelines remains unknown. The purpose of this study was to evaluate annual trends in SSRF timing and implication on associated morbidity and mortality.
Methods: In the 2017-2021Trauma Quality Improvement Program (TQIP), adults undergoing SSRF with >1 rib fracture were identified and further categorized into early (≤ 72 hours) and late (>72 hours). Pulmonary morbidity was defined as reintervention, tracheostomy, and respiratory complication, while overall morbidity included all TQIP in-hospital complications. Annual SSRFs were compared with Chi2, and outcomes with Cochran-Mantel-Haenszel statistics, controlling for SSRF timing. The interaction of SSRF timing, year and combination therof was determined with multiple logistic regression, where a negative beta value represented improvement the outcome.
Results: We identified 668,615 adults with multiple rib fractures with 15,392 SSRFs, with 55.5% occurring early and 44.5% late. Annual cases of SSRF from 2017 to 2021 nearly doubled (2155 vs 4147, respectively) with a relative increase in early SSRF (49.4 vs 58.1%) and decrease in late SSRF (50.6 vs 41.9%)(p<.001). On multiple logistic regression, early SSRF and successive year was associated with improved pulmonary morbidity and nonhome discharge (p<.005), while only early SSRF positively impacted overall morbidity (p<.005). SSRF timing and year did not impact mortality (p>.05).
Conclusion: Our study demonstrates the nationwide adoption of early, operative management of rib fractures. Pulmonary morbidity is improved with early SSRF and successive year, supporting the validity of the current guidelines.