Surgical stabilization of rib fractures in adult trauma patients with flail chest with or without severe traumatic brain injury: A national analysis.

INTRODUCTION We aim to compare clinical outcomes of surgical stabilization of rib fractures (SSRF) versus non-operative management (NOM) in adult non-TBI patients with isolated flail chest and severe TBI patients with flail chest.

Methods

A retrospective cohort analysis was performed utilizing the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset from 2017 to 2021. Adult non-TBI trauma patients with isolated flail chests and severe TBI patients with flail chests were included. Outcomes included in-hospital mortality, intensive care unit length of stay (ICU-LOS), ventilator-free days (VFDs), in-hospital complications, and discharge disposition.

Results

Among non-TBI patients, there was no significant difference in in-hospital mortality between SSRF and NOM patients (OR 0.565, 95% CI 0.261-1.222, p = 0.147). Among severe TBI patients, SSRF was associated with significantly lower odds of in-hospital mortality (OR 0.275, 95% CI 0.088-0.859, p = 0.026). In both non-TBI and TBI patients, SSRF was associated with significantly longer ICU-LOS (Β=2.434, 95% CI 1.796-3.098, p < 0.001; Β=5.009, 95% CI 2.866-7.151, p < 0.001), increased odds of ventilator-associated pneumonia (VAP) (OR 4.051, 95% CI 1.573-10.435, p = 0.004; OR 4.066, 95% CI 1.501-11.019, p = 0.006), tracheostomy (OR 2.061, 95% CI 1.143-3.716, p = 0.016;OR 3.797, 95% CI 1.861-7.744, p < 0.001), and discharge to inpatient rehab (OR 1.452, 95% CI 1.089-1.935, p = 0.011; OR 2.140, 95% CI 1.159-3.949, p = 0.015) compared to NOM.

Conclusion

In adult non-TBI trauma patients with isolated flail chest, SSRF is associated with comparable mortality when compared to NOM. Among severe TBI patients with flail chest, SSRF is associated with significantly reduced odds of in-hospital mortality.