年龄对连枷胸患者肋骨骨折手术固定的阻碍。
Age as a Barrier to Surgical Stabilization of Rib Fractures in Patients with Flail Chest.
机构信息
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Division of Trauma, Critical Care, Burns, & Acute Care Surgery, Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA.
出版信息
Am Surg. 2023 Apr;89(4):927-934. doi: 10.1177/00031348211047490. Epub 2021 Nov 3.
INTRODUCTION
Although randomized trials demonstrate a benefit to surgical stabilization of rib fractures (SSRF), SSRF is rarely performed. We hypothesized older patients were less likely to receive SSRF nationally.
METHODS
The 2016 National Inpatient Sample was used to identify adults with flail chest. Comorbidities and receipt of SSRF were categorized by ICD-10 code. Univariable testing and Multivariable regression were performed to determine the association of demographic characteristics and comorbidities to receipt of SSRF.
RESULTS
1021 patients with flail chest were identified, including 244 (23.9%) who received SSRF. Patients ≥70 years were less likely to receive SSRF. (<70 yrs 201/774 [26.0%] vs ≥70 43/247 [17.4%], = .006) and had higher risk of death (<70 yrs 39/774 [5.0%] vs ≥70 33/247 [13.4%], < .001) In multivariable modeling, only age ≥70 years was associated with SSRF (OR .591, = .005).
CONCLUSION
Despite guideline-based support of SSRF in flail chest, SSRF is performed in <25% of patients. Age ≥70 years is associated with lower rate of SSRF and higher risk of death. Future study should examine barriers to SSRF in older patients.
介绍
尽管随机试验证明了外科固定肋骨骨折（SSRF）的益处，但 SSRF 很少进行。我们假设全国范围内老年患者接受 SSRF 的可能性较低。
方法
使用 2016 年国家住院患者样本确定患有连枷胸的成年人。根据 ICD-10 代码对合并症和 SSRF 的接受情况进行分类。进行单变量检验和多变量回归，以确定人口统计学特征和合并症与接受 SSRF 的关联。
结果
确定了 1021 例连枷胸患者，其中 244 例（23.9%）接受了 SSRF。≥70 岁的患者接受 SSRF 的可能性较低。（<70 岁 201/774 [26.0%] 比≥70 岁 43/247 [17.4%]， =.006），并且死亡风险更高（<70 岁 39/774 [5.0%] 比≥70 岁 33/247 [13.4%]， <.001）。在多变量模型中，只有年龄≥70 岁与 SSRF 相关（OR.591， =.005）。
结论
尽管连枷胸的 SSRF 有基于指南的支持，但只有不到 25%的患者接受了 SSRF。年龄≥70 岁与 SSRF 发生率较低和死亡风险较高相关。未来的研究应检查老年患者 SSRF 的障碍。
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