连枷胸肋骨骨折的早期手术固定可改善患者预后：ACS-TQIP 回顾性研究。
Early surgical stabilization of rib fractures for flail chest is associated with improved patient outcomes: An ACS-TQIP review.
机构信息
From the Division of Acute Care Surgery, Department of Surgery (A.S., K.A., Y.A., L.W., J.F.W., J.B., S.W.L., M.B.A., E.B.R.), Virginia Commonwealth University, and Virginia Commonwealth University School of Medicine (J.S., M.C.), Richmond, Virginia.
出版信息
J Trauma Acute Care Surg. 2023 Apr 1;94(4):532-537. doi: 10.1097/TA.0000000000003809.
BACKGROUND
Rib fractures are a common in thoracic trauma. Increasingly, patients with flail chest are being treated with surgical stabilization of rib fractures (SSRF). We performed a retrospective review of the Trauma Quality Improvement Program database to determine if there was a difference in outcomes between patients undergoing early SSRF (≤3 days) versus late SSRF (>3 days).
METHODS
Patients with flail chest in Trauma Quality Improvement Program were identified by CPT code, assessing those who underwent SSRF between 2017 and 2019. We excluded those younger than 18 years and Abbreviated Injury Scale head severity scores greater than 3. Patients were grouped based on SSRF before and after hospital Day 3. These patients were case matched based on age, Injury Severity Score, Abbreviated Injury Scale head and chest, body mass index, Glasgow Coma Scale, and five modified frailty index. All data were examined using χ2, one-way analysis of variance, and Fisher's exact test within SPSS version 28.0.
RESULTS
For 3 years, 20,324 patients were noted to have flail chest, and 3,345 (16.46%) of these patients underwent SSRF. After case matching, 209 patients were found in each group. There were no significant differences between reported major comorbidities. Patients with early SSRF had fewer unplanned intubations (6.2% vs. 12.0%; p = 0.04), fewer median ventilator days (6 days Q1: 3 to Q3: 10.5 vs. 9 Q1: 4.25 to Q3: 14; p = 0.01), shorter intensive care unit length of stay (6 days Q1: 4 to Q3: 11 vs. 11 Q1: 6 to Q3: 17; p < 0.01), and hospital length of stay (15 days Q1: 11.75 to Q3: 22.25 vs. 20 Q1: 15.25 - Q3: 27, p < 0.01. Early plating was associated with lower rates of deep vein thrombosis and ventilator-acquired pneumonia.
CONCLUSION
In trauma-accredited centers, patients with flail chest who underwent early SSRF (<3 days) had better outcomes, including fewer unplanned intubations, decreased ventilator days, shorter intensive care unit LOS and HLOS, and fewer DVTs, and ventilator-associated pneumonia.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
背景
肋骨骨折是胸部创伤的常见并发症。越来越多的连枷胸患者接受肋骨骨折内固定术（SSRF）治疗。我们对创伤质量改进计划数据库进行了回顾性分析，以确定在≤3 天内进行早期 SSRF 与>3 天内进行晚期 SSRF 之间的患者结局是否存在差异。
方法
通过 CPT 代码确定创伤质量改进计划数据库中的连枷胸患者，并评估在 2017 年至 2019 年期间接受 SSRF 的患者。排除年龄<18 岁和损伤严重程度评分头部>3 的患者。根据 SSRF 在住院第 3 天之前和之后将患者分为两组。基于年龄、创伤严重程度评分、头部和胸部损伤严重程度评分、身体质量指数、格拉斯哥昏迷评分和五个改良脆弱指数对这些患者进行病例匹配。使用 SPSS 版本 28.0 中的 χ2、单因素方差分析和 Fisher 精确检验对所有数据进行检查。
结果
3 年来，共有 20324 例患者被诊断为连枷胸，其中 3345 例（16.46%）患者接受了 SSRF。病例匹配后，每组发现 209 例患者。两组报告的主要合并症无显著差异。早期 SSRF 患者的计划性插管更少（6.2%比 12.0%；p=0.04），机械通气天数更少（中位数 6 天 Q1：3 至 Q3：10.5 比 9 Q1：4.25 至 Q3：14；p=0.01），重症监护病房住院时间更短（6 天 Q1：4 至 Q3：11 比 11 Q1：6 至 Q3：17；p<0.01），住院时间更短（15 天 Q1：11.75 至 Q3：22.25 比 20 Q1：15.25 至 Q3：27，p<0.01）。早期钢板固定与较低的深静脉血栓形成和呼吸机相关性肺炎发生率相关。
结论
在创伤认证中心，接受早期 SSRF（<3 天）的连枷胸患者结局更好，包括计划性插管更少、机械通气天数减少、重症监护病房住院时间和住院时间缩短，以及深静脉血栓形成和呼吸机相关性肺炎发生率更低。
证据水平
治疗/护理管理；IV 级。
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