Christie Dudley B, Nowack Timothy E, Nonnemacher Cory J, Montgomery Anne, Ashley Dennis W
417871Navicent Health Systems, Macon, GA, USA.
Department of Trauma Surgery and Critical Care, 12241Mercer University School of Medicine, Macon, GA, USA.
Am Surg. 2022 Apr;88(4):658-662. doi: 10.1177/00031348211060432. Epub 2022 Jan 3.
Rib fractures in the ≥65-year-old population have been shown to strongly influence mortality and pneumonia rates. There is a growing body of evidence demonstrating improvements in the geriatric patient's survival statistics and respiratory performances after surgical stabilization of rib fractures (SSRF). We have observed a strong survival and complication avoidance trend in geriatric patients who undergo SSRF. The purpose of our study was to evaluate the outcomes of geriatric patients with rib fractures treated with SSRF compared to those who only receive conservative therapies.
We performed a retrospective review of our trauma registry analyzing outcomes of patients ≥65 years with rib fractures. Patients admitted from 2015 to 2019 receiving SSRF (RP group) were compared to a nonoperative controls (NO group) admitted during the same time. Bilateral fractures were excluded. Independent variables analyzed = ISS, mortalities, hospital days, ICU days, pleural space complications, and readmissions. Follow-up was 60 days after discharge. Group comparison was performed using Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U tests.
257 patients were analyzed: 172 in the NO group with mean age of 75 (65-10) and 85 in the RP group with mean age of 74 (65-96). Mean ISS = 13 (1-38) for the NO group and 20 (9-59) for the RP group ( < .001). Mean hospital days = 8 (1-39) and 15 (3-49) in NO and RP groups, respectively. Mean ICU days = 10 (1-32) and 8 (1-11) in NO and RP groups, respectively. Deaths, pneumonia, readmissions, and pleural effusions in the NO group were statistically significant ( < .01). Analysis of complications revealed 4 RP patients (4.7%) with respiratory complications out to 60 days and 65 NO patients (37.8%) ( < .001).
Surgical stabilization of rib fractures appears to be associated with a survival advantage and an avoidance of respiratory-related complications in the ≥65-year-old patient population.
研究表明，65岁及以上人群的肋骨骨折对死亡率和肺炎发生率有显著影响。越来越多的证据表明，肋骨骨折手术固定（SSRF）后老年患者的生存统计数据和呼吸功能有所改善。我们观察到接受SSRF的老年患者有很强的生存和避免并发症的趋势。我们研究的目的是评估接受SSRF治疗的老年肋骨骨折患者与仅接受保守治疗的患者的治疗效果。
我们对创伤登记处进行了回顾性分析，分析65岁及以上肋骨骨折患者的治疗结果。将2015年至2019年接受SSRF的患者（RP组）与同期入院的非手术对照组（NO组）进行比较。排除双侧骨折患者。分析的自变量包括：损伤严重度评分（ISS）、死亡率、住院天数、重症监护病房（ICU）天数、胸腔并发症和再入院情况。出院后随访60天。使用柯尔莫哥洛夫-斯米尔诺夫检验、夏皮罗-威尔克检验和曼-惠特尼U检验进行组间比较。
共分析了257例患者：NO组172例，平均年龄75岁（65-10岁）；RP组85例，平均年龄74岁（65-96岁）。NO组的平均ISS为13（1-38），RP组为20（9-59）（P<0.001）。NO组和RP组的平均住院天数分别为8天（1-39天）和15天（3-49天）。NO组和RP组的平均ICU天数分别为10天（1-32天）和8天（1-11天）。NO组的死亡、肺炎、再入院和胸腔积液情况具有统计学意义（P<0.01）。并发症分析显示，RP组有4例患者（4.7%）在60天内出现呼吸并发症，NO组有65例患者（37.8%）出现呼吸并发症（P<0.001）。
肋骨骨折手术固定似乎能使65岁及以上患者获得生存优势并避免呼吸相关并发症。
