手术与非手术治疗多发肋骨骨折的结局：美国医院匹配队列数据库分析。
Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: A US hospital matched cohort database analysis.
机构信息
From the Penn Center for Chest Trauma (A.M.S.), Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; DePuy Synthes (S.W.), Johnson & Johnson Medical GmbH, Norderstedt, Germany; DePuy Synthes (A.W., M.V.), West Chester, Pennsylvania; Mu Sigma (M.A.), Bengaluru, Karnataka, India; MEDTECH Epidemiology (J.W.R., C.E.H.), Johnson & Johnson, New Brunswick, New Jersey; Johnson and Johnson Medical (T.G.), Issy Les Moulineaux, France.
出版信息
J Trauma Acute Care Surg. 2023 Apr 1;94(4):538-545. doi: 10.1097/TA.0000000000003828. Epub 2022 Nov 15.
BACKGROUND
Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design.
METHODS
Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links.
RESULTS
A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245).
CONCLUSION
Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
多发性肋骨骨折的治疗包括肋骨骨折的手术固定（SSR）或非手术治疗（NOM）。荟萃分析表明，与 NOM 相比，SSR 可更快地恢复并降低长期并发症的发生率。我们的研究在真实世界的所有患者研究设计中，评估了多发性肋骨骨折患者 SSR 与 NOM 后的术后结果。
方法
从 2015 年 10 月 1 日至 2020 年 9 月 30 日，从 PREMIER 医院数据库中确定了多发性肋骨骨折患者的住院治疗情况。结果包括出院处置和 3 个月和 12 个月的肺部相关再入院情况。为所有患者确定了人口统计学、合并症、指数相关的并发伤、简明损伤评分和损伤严重程度评分以及提供者特征。如果患者的胸廓简明损伤评分<2（低严重程度患者）或格拉斯哥昏迷评分≤8（极高严重程度患者），则将其从队列中排除。SSR 和 NOM 患者之间采用精细分层和加权进行分层匹配，以便最终分析中保留所有患者的数据。使用具有拟正态分布和对数链接的广义线性模型分析结果。
结果
共纳入 203450 名患者，其中 200580 名接受 NOM 治疗，2870 名接受 SSR 治疗。与 NOM 相比，SSR 治疗的患者出院回家的比例更高（SSR 为 62%，NOM 为 58%），肺部相关再入院率较低（3 个月时，SSR 为 3.1%，NOM 为 4.0%；12 个月时，SSR 为 6.2%，NOM 为 7.6%）。与 NOM 相比，SSR 治疗的患者出院回家的优势比（OR）为 1.166（95%置信区间[CI]，1.073-1.266；p=0.0002）。同样，SSR 治疗的患者在 3 个月和 12 个月时肺部相关再入院的 OR 也明显低于 NOM 治疗的患者（OR[3 个月]，0.764[95%CI，0.606-0.963]；p=0.0227和 OR[12 个月]，0.799[95%CI，0.657-0.971]；p=0.0245）。
结论
与 NOM 相比，12 个月随访时，肋骨骨折的手术固定可使出院回家的可能性更高，肺部相关再入院率更低。
证据水平
治疗/护理管理；III 级。
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