Badrinathan Avanti, Sarode Anuja L, Alvarado Christine E, Sinopoli Jillian, Rice Jonathan D, Linden Philip A, Moorman Matthew L, Towe Christopher W
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Trauma Surg Acute Care Open. 2023 Apr 3;8(1):e000994. doi: 10.1136/tsaco-2022-000994. eCollection 2023.
Surgical stabilization of rib fractures (SSRF) is performed on only a small subset of patients who meet guideline-recommended indications for surgery. Although previous studies show that provider specialization was associated with SSRF procedural competency, little is known about the impact of provider specialization on SSRF performance frequency. We hypothesize that provider specialization would impact performance of SSRF.
The Premier Hospital Database was used to identify adult patients with rib fractures from 2015 and 2019. The outcome of interest was performance of SSRF, defined using International Classification of Diseases-10th Revision Procedure Coding System coding. Patients were categorized as receiving their procedures from a thoracic, general surgeon, or orthopedic surgeon. Patients with missing or other provider types were excluded. Multivariate modeling was performed to evaluate the effect of surgical specialization on outcomes of SSRF. Given a priori assumptions that trauma centers may have different practice patterns, a subgroup analysis was performed excluding patients with 'trauma center' admissions.
Among 39 733 patients admitted with rib fractures, 2865 (7.2%) received SSRF. Trauma center admission represented a minority (1034, 36%) of SSRF procedures relative to other admission types (1831, 64%, p=0.15). In a multivariable analysis, thoracic (OR 6.94, 95% CI 5.94-8.11) and orthopedic provider (OR 2.60, 95% CI 2.16-3.14) types were significantly more likely to perform SSRF. In further analyses of trauma center admissions versus non-trauma center admissions, this pattern of SSRF performance was found at non-trauma centers.
The majority of SSRF procedures in the USA are being performed by general surgeons and at non-trauma centers. 'Subspecialty' providers in orthopedics and thoracic surgery are performing fewer total SSRF interventions, but are more likely to perform SSRF, especially at non-trauma centers. Provider specialization as a barrier to SSRF may be related to competence in the SSRF procedures and requires further study.
Therapeutic/care management.
IV.
肋骨骨折手术固定（SSRF）仅在符合指南推荐手术指征的一小部分患者中进行。尽管先前的研究表明医疗服务提供者的专业背景与SSRF手术能力相关，但对于医疗服务提供者的专业背景对SSRF实施频率的影响知之甚少。我们假设医疗服务提供者的专业背景会影响SSRF的实施。
使用Premier医院数据库识别2015年至2019年的成年肋骨骨折患者。感兴趣的结果是SSRF的实施情况，使用国际疾病分类第十版手术编码系统编码进行定义。患者被分类为接受来自胸外科医生、普通外科医生或骨科医生的手术。排除手术医生信息缺失或为其他类型的患者。进行多变量建模以评估手术专业背景对SSRF结果的影响。鉴于创伤中心可能有不同的实践模式这一先验假设，进行了亚组分析，排除了有“创伤中心”入院记录的患者。
在39733例肋骨骨折入院患者中，2865例（7.2%）接受了SSRF。与其他入院类型（1831例，64%）相比，创伤中心入院的患者在SSRF手术中占少数（1034例，36%，p = 0.15）。在多变量分析中，胸外科医生（OR 6.94，95%CI 5.94 - 8.11）和骨科医生（OR 2.60，95%CI 2.16 - 3.14）进行SSRF手术的可能性显著更高。在对创伤中心入院患者与非创伤中心入院患者的进一步分析中，在非创伤中心发现了这种SSRF手术实施模式。
美国大多数SSRF手术由普通外科医生在非创伤中心进行。骨科和胸外科的“专科”医生进行的SSRF干预总数较少，但进行SSRF手术的可能性更大，尤其是在非创伤中心。医疗服务提供者的专业背景作为SSRF的一个障碍可能与SSRF手术的能力有关，需要进一步研究。
治疗/护理管理。
IV级。
