肋骨骨折手术固定的时机：它会影响治疗结果吗？
Time to surgical stabilization of rib fractures: does it impact outcomes?
作者信息
Forrester Joseph D, Sarani Babak, Forssten Maximilian Peter, Cao Yang, Hildebrand Frank, Mohammad Ismail Ahmad, Ribeiro Marcelo A F, Mohseni Shahin
机构信息
Stanford University, Stanford, California, USA.
Center of Trauma and Critical Care, The George Washington University, Washington, District of Columbia, USA.
出版信息
Trauma Surg Acute Care Open. 2024 Jul 11;9(1):e001233. doi: 10.1136/tsaco-2023-001233. eCollection 2024.
OBJECTIVES
Rib fractures are common, morbid, and potentially lethal. Intuitively, if interventions to mitigate downstream effects of rib fractures can be implemented early, likelihood of developing these complications should be reduced. Surgical stabilization of rib fractures (SSRF) is one therapeutic intervention shown to be useful for mitigating complications of these common fractures. Our aim was to investigate for association between time to SSRF and complications among patients with isolated rib fractures undergoing SSRF.
METHODS
The 2016-2019 American College of Surgeons Trauma Quality Improvement Program (TQIP) database was queried to identify patient >18 years with isolated thoracic injury undergoing SSRF. Patients were divided into three groups: SSRF ≤2 days, SSRF >2 days but <3 days, and SSRF >3 days. Poisson regression, and adjusting for demographic and clinical covariates, was used to evaluate the association between time to SSRF and the primary endpoint, in-hospital complications. Quantile regression was used to evaluate the effects of time to SSRF on the secondary endpoints, hospital and intensive care unit (ICU) length of stay (LOS).
RESULTS
Out of 2185 patients, 918 (42%) underwent SSRF <2 days, 432 (20%) underwent SSRF >2 days but <3 days, and 835 (38%) underwent SSRF >3 days. Hemothorax was more common among patients undergoing SSRF >3 days, otherwise all demographic and clinical variables were similar between groups. After adjusting for potential confounding, SSRF >3 days was associated with a threefold risk of composite in-hospital complications (adjusted incidence rate ratio: 3.15, 95% CI 1.76 to 5.62; p<0.001), a 4-day increase in total hospital LOS (change in median LOS: 4.09; 95% CI 3.69 to 4.49, p<0.001), and a nearly 2-day increase in median ICU LOS (change in median LOS: 1.70; 95% CI 1.32 to 2.08, p<0.001), compared with SSRF ≤2 days.
CONCLUSION
Among patients undergoing SSRF in TQIP, earlier SSRF is associated with less in-hospital complications and shorter hospital stays. Standardization of time to SSRF as a trauma quality metric should be considered.
LEVEL OF EVIDENCE
Level II, retrospective.
目的
肋骨骨折很常见，病情严重，且可能致命。直观地说，如果能够尽早实施干预措施以减轻肋骨骨折的下游影响，那么发生这些并发症的可能性应该会降低。肋骨骨折手术固定（SSRF）是一种已被证明对减轻这些常见骨折并发症有用的治疗干预措施。我们的目的是研究接受SSRF的单纯肋骨骨折患者中，至SSRF的时间与并发症之间的关联。
方法
查询2016 - 2019年美国外科医师学会创伤质量改进项目（TQIP）数据库，以识别年龄>18岁、接受SSRF且有单纯胸部损伤的患者。患者分为三组：SSRF≤2天、SSRF>2天但<3天、SSRF>3天。采用泊松回归并调整人口统计学和临床协变量，以评估至SSRF的时间与主要终点（院内并发症）之间的关联。采用分位数回归评估至SSRF的时间对次要终点（住院时间和重症监护病房（ICU）住院时间（LOS））的影响。
结果
在2185例患者中，918例（42%）在<2天内接受了SSRF，432例（20%）在>2天但<3天内接受了SSRF，835例（38%）在>3天内接受了SSRF。血胸在接受SSRF>3天的患者中更常见，除此之外，各组之间所有人口统计学和临床变量均相似。在调整潜在混杂因素后，与SSRF≤2天相比，SSRF>3天与复合院内并发症风险增加两倍相关（调整后的发病率比：3.15，95%可信区间1.76至5.62；p<0.001），总住院LOS增加4天（中位LOS变化：4.09；95%可信区间3.69至4.49，p<0.001），中位ICU LOS增加近2天（中位LOS变化：1.70；95%可信区间1.32至2.08，p<0.001）。
结论
在TQIP中接受SSRF的患者中，更早进行SSRF与更少的院内并发症和更短的住院时间相关。应考虑将至SSRF的时间标准化作为一项创伤质量指标。
证据水平
二级，回顾性研究。
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