Pieracci FM, et al. - Researchers performed a multicenter evaluation of the optimal timing of surgical stabilization of rib fractures (SSRF). SSRF within 1 day of admission seemed correlated with certain demographic and physiologic variables. After controlling for confounding covariates, early SSRF was performed using less operative time and was associated with favorable outcomes. SSRF ought to occur as early as possible when indicated and feasible.

Methods

• Researchers merged and analyzed prospectively collected SSRF databases from four trauma centers (2006–2016).
• Days from hospital admission to SSRF constituted the independent variable (early [<1 day], mid [1–2 days], and late [3–10 days]).
• Length of operation, number of ribs repaired, prolonged (>24 hours) mechanical ventilation, pneumonia, tracheostomy, length of stay, and mortality were the outcome measures.
• They used multivariable logistic regression to control for significant differences in covariates between groups.

Results

• Researchers analyzed 551 patients.
• The median time to SSRF of 1 day (range, 0–10) was observed.
• Two hundred seven (37.6%) patients were in the early group, 168 (30.5%) in the midgroup, and 186 (31.9%) in the late group.
• Over the study period, they noticed a significant shift toward earlier SSRF.
• Significant association of time to SSRF was noticed with study center (p < 0.01), year of surgery (p < 0.01), age (p=0.02), mechanism of injury (p=0.04), and body mass index (p=0.02).
• No association of injury severity was observed with time to surgery.
• Median length of surgery was 68 minutes longer for the late as compared to the early group (p < 0.01) despite repairing the same median number of ribs (4; range, 1–13).
• Each additional hospital day before SSRF was independently associated with a 31% increased likelihood of pneumonia (p < 0.01), a 27% increased likelihood of prolonged mechanical ventilation (p < 0.01), and a 26% increased likelihood of tracheostomy (p < 0.01), after controlling for the aforementioned significant covariates.