Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
World J Surg. 2023 Jul;47(7):1692-1703. doi: 10.1007/s00268-023-06973-y. Epub 2023 Apr 4.
Surgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures.
Dutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator.
Sixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P-P 4-12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001).
For adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.
外科固定多发肋骨骨折（Surgical Stabilization of Rib Fractures，SSRF）可改善连枷胸患者的呼吸症状并缩短重症监护病房的住院时间。对于多发性肋骨骨折，SSRF 的益处仍然存在争议。本研究旨在调查医疗保健专业人员对 SSRF 作为多发性创伤性肋骨骨折治疗方法的障碍和促进因素。
要求荷兰医疗保健专业人员填写改良版的创新测量工具（Measurement Instrument for Determinants of Innovations）问卷，以确定 SSRF 的障碍和促进因素。如果有≥20%的参与者做出否定回答，则该项目被视为障碍；如果有≥80%的参与者做出肯定回答，则该项目被视为促进因素。
共有 61 名医疗保健专业人员参与，其中 32 名为外科医生，19 名为非外科医生，10 名为住院医师。中位经验为 10 年（P-P 4-12）。确定了 16 个 SSRF 在多发性肋骨骨折中的障碍因素和 2 个促进因素。障碍因素包括缺乏知识、经验、（成本）效益证据，以及更多手术和更高医疗费用的影响。促进因素包括 SSRF 缓解呼吸问题的假设，以及外科医生得到同事支持进行 SSRF 的感觉。非外科医生和住院医师报告的障碍因素比外科医生多且不同（外科医生：14 个；非外科医生：20 个；住院医师：21 个；p<0.001）。
为了在多发性肋骨骨折患者中充分实施 SSRF，实施策略应针对确定的障碍因素。特别是，提高医疗保健专业人员的临床经验和科学知识，以及 SSRF 的（成本）效益的高级别证据，可能会增加其使用和接受程度。
