Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2020 Sep;110(3):988-992. doi: 10.1016/j.athoracsur.2020.03.084. Epub 2020 Apr 30.
The appropriate timing of rib fixation remains unclear. We investigated the efficacy of early rib fixation compared with late rib fixation, using data from a Japanese nationwide inpatient database.
We identified patients who underwent rib fixation and received mechanical ventilation from July 1, 2010, to March 31, 2018, using data from the Diagnosis Procedure Combination database in Japan. The primary outcome was the duration of mechanical ventilation after rib fixation. Secondary outcomes were the length of hospital stay after rib fixation, total hospitalization costs, tracheostomy, pneumonia after admission, and all-cause 28-day in-hospital mortality. We performed propensity score-adjusted analyses to compare outcomes between patients undergoing rib fixation less than or equal to 6 days after admission and those undergoing rib fixation greater than 6 days after admission.
We identified 211 patients, including 113 patients undergoing early rib fixation and 98 patients undergoing late rib fixation. In the propensity score-adjusted analyses, early rib fixation was associated with shorter duration of mechanical ventilation (difference, -26.7%; 95% confidence interval [CI], -39.4% to -11.4%), shorter length of hospital stay (difference, -33.3%; 95% CI, -52.8% to -5.6%), and lower total hospitalization costs (difference, -28.7%; 95% CI, -38.4% to -17.5%). There were no significant differences between the groups regarding the proportions of patients receiving tracheostomy (odds ratio [OR], 0.67; 95% CI, 0.31-1.48), pneumonia after admission (OR, 0.74, 95% CI, 0.33-1.65), or all-cause 28-day in-hospital mortality (OR, 0.90, 95% CI, 0.06-12.5).
Early rib fixation was associated with better in-hospital outcomes.
肋骨固定的合适时机仍不清楚。我们利用来自日本全国住院患者数据库的数据，研究了早期与晚期肋骨固定的疗效。
我们利用日本诊断程序组合数据库的数据，确定了 2010 年 7 月 1 日至 2018 年 3 月 31 日期间接受肋骨固定和机械通气的患者。主要结果是肋骨固定后机械通气的持续时间。次要结果是肋骨固定后的住院时间、总住院费用、气管切开术、入院后肺炎和全因 28 天院内死亡率。我们进行了倾向评分调整分析，以比较入院后 6 天内和 6 天后接受肋骨固定的患者的结果。
我们确定了 211 名患者，包括 113 名接受早期肋骨固定的患者和 98 名接受晚期肋骨固定的患者。在倾向评分调整分析中，早期肋骨固定与机械通气持续时间更短（差异为-26.7%；95%置信区间[CI]为-39.4%至-11.4%）、住院时间更短（差异为-33.3%；95%CI为-52.8%至-5.6%）和总住院费用更低（差异为-28.7%；95%CI为-38.4%至-17.5%）有关。两组之间接受气管切开术的患者比例（优势比[OR]为 0.67；95%CI为 0.31-1.48）、入院后肺炎（OR 为 0.74，95%CI 为 0.33-1.65）或全因 28 天院内死亡率（OR 为 0.90，95%CI 为 0.06-12.5）均无显著差异。
早期肋骨固定与更好的住院结果相关。
