Ohio Health Riverside Methodist Hospital, 3535 Olentangy River Road Columbus, Ohio 43214, USA.
Ohio Health Riverside Methodist Hospital, 3535 Olentangy River Road Columbus, Ohio 43214, USA.
Injury. 2023 Sep;54(9):110871. doi: 10.1016/j.injury.2023.110871. Epub 2023 Jun 4.
Surgical stabilization of rib fractures (SSRF) has demonstrated benefit in patients with flail chest and multiple displaced fractures. There is mounting evidence for SSRF following chest wall injury (CWI) for the geriatric trauma population. A recent multi-center retrospective study highlighted a mortality benefit even for those patients aged 80 years and older. The objective of this investigation was to review our institutional experience with both in- and out-of-hospital outcomes within this patient population following SSRF.
A retrospective review of patients 80 years and older was performed at a high-volume level 2 trauma center from 2017 to 2021. SSRF volume is routinely >60 cases per year. Perioperative, inpatient, and outpatient data were collected as available. Primary outcomes were inpatient and 90-day mortality. Secondary outcomes included discharge on narcotics and freedom from narcotics at 30 days.
50 patients were included for review. Mean age was 86 years and mechanism of injury was most often fall. 28 of 50 (56%) patients had flail chest (radiographic). Mean number of ribs fixated was 4.7 and time to surgery 2.5 days. Inpatient mortality was 3/50 (6%), 90-day mortality was 9/50 (18%) of which three were attributable primarily to CWI (6/50, 12%). Of patients with follow-up of 1 year and beyond, 27/28 were alive (96%). With respect to narcotic consumption, 45% (21/47) were discharged on narcotics with 90% (28/31; N limited by missing data) being narcotic-free at 30 days.
In this high-risk patient population, inpatient mortality was comparably low to prior reports, though 90-day mortality was doubled when incorporating CWI-related deaths. Narcotic use was seen in the minority of patients upon discharge, and most progressed to being narcotic-free at 30 days post-hospitalization. Inpatient outcomes alone may not adequately define both the benefit and risk of SSRF performed in patients 80 years and older.
外科固定肋骨骨折（SSRF）已被证明对连枷胸和多发性移位性骨折患者有益。越来越多的证据表明，在老年创伤患者中，胸壁损伤（CWI）后也需要 SSRF。最近的一项多中心回顾性研究强调，即使对于 80 岁及以上的患者，SSR 也具有生存获益。本研究旨在回顾我们机构在 SSRF 后治疗该患者人群的院内和院外结局的经验。
对 2017 年至 2021 年在一家大容量 2 级创伤中心的 80 岁及以上患者进行回顾性研究。SSR 年例数通常>60 例。收集了围手术期、住院和门诊数据。主要结局为住院和 90 天死亡率。次要结局包括出院时使用阿片类药物和 30 天内无阿片类药物。
共纳入 50 例患者进行回顾性分析。平均年龄为 86 岁，损伤机制多为跌倒。50 例患者中，28 例（56%）有连枷胸（影像学表现）。平均固定肋骨数为 4.7 根，手术时间为 2.5 天。住院死亡率为 3/50（6%），90 天死亡率为 9/50（18%），其中 3 例主要归因于 CWI（6/50，12%）。在随访 1 年以上的患者中，28 例存活（96%）。在阿片类药物的使用方面，45%（21/47）出院时使用阿片类药物，90%（28/31；由于数据缺失，N 有限）在 30 天时无阿片类药物。
在这一高危患者人群中，住院死亡率与既往报道相似，但将与 CWI 相关的死亡纳入后，90 天死亡率增加了一倍。出院时，只有少数患者使用阿片类药物，大多数患者在住院后 30 天内无阿片类药物。仅观察住院结局可能无法充分定义 80 岁及以上患者 SSRF 的获益和风险。
