Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2024 Oct;302:420-427. doi: 10.1016/j.jss.2024.07.081. Epub 2024 Aug 16.
Surgical stabilization of rib fractures (SSRF) is associated with lower rates of mortality and fewer complications. This study evaluates whether the decision to undergo SSRF is associated with age, race, ethnicity, and insurance status and assesses associated clinical outcomes.
This retrospective analysis included patients ≥45 y old with rib fractures who underwent SSRF in the Trauma Quality Improvement Program from 2016 to 2020. Race, ethnicity, and insurance statuses were collected. Age in years was dichotomized into two groups: 45-64 and 65+. Outcomes included ventilator-associated pneumonia, unplanned endotracheal intubation, acute respiratory distress syndrome, in-hospital mortality, failure to rescue (FTR) after major complications, and FTR after respiratory complications. Logistic regression models were fit to evaluate outcomes, controlling for gender, body mass index, Injury Severity Score, flail chest, chronic obstructive pulmonary disease, congestive heart failure, and smoking.
Two thousand eight hundred thirty-nine patients aged 45-64 and 1828 patients aged 65+ underwent SSRF. No significant difference in clinical outcomes was noted between these groups. Analysis showed that the association of SSRF with ventilator-associated pneumonia, unplanned intubation, acute respiratory distress syndrome, in-hospital mortality, FTR after a major complication, or FTR after a respiratory complication did not vary by age (P > 0.05). Black (odds ratio [OR] 0.67; 95% confidence interval [CI]: 0.59-0.77; P < 0.001), Hispanic (OR 0.80; 95% CI: 0.71-0.91; P < 0.001), and Medicaid (OR = 0.85; 95% CI = 0.76-0.95; P = 0.005) patients were less likely to receive SSRF.
No differences in clinical outcomes were measured between adults aged 45-64 and ≥65 who underwent SSRF. Older age should not preclude patients from receiving SSRF. Further work is needed to improve underutilization in Black, Hispanic and Medicaid patients.
肋骨骨折的外科固定（Surgical stabilization of rib fractures，SSRF）与死亡率降低和并发症减少相关。本研究评估了接受 SSRF 是否与年龄、种族、族裔和保险状况有关，并评估了相关的临床结局。
本回顾性分析纳入了 2016 年至 2020 年在创伤质量改进计划中接受 SSRF 的年龄≥45 岁的肋骨骨折患者。收集了种族、族裔和保险状况。年龄以 45-64 岁和 65+岁分为两组。结局包括呼吸机相关性肺炎、计划性气管插管、急性呼吸窘迫综合征、院内死亡率、重大并发症后抢救失败（failure to rescue，FTR）和呼吸并发症后 FTR。采用逻辑回归模型评估结局，控制性别、体重指数、损伤严重程度评分、连枷胸、慢性阻塞性肺疾病、充血性心力衰竭和吸烟状况。
2839 名 45-64 岁患者和 1828 名 65+岁患者接受了 SSRF。两组患者的临床结局无显著差异。分析表明，SSRF 与呼吸机相关性肺炎、计划性插管、急性呼吸窘迫综合征、院内死亡率、重大并发症后 FTR 或呼吸并发症后 FTR 之间的关联不因年龄而异（P>0.05）。黑人（比值比[odds ratio，OR] 0.67；95%置信区间[confidence interval，CI]：0.59-0.77；P<0.001）、西班牙裔（OR 0.80；95%CI：0.71-0.91；P<0.001）和医疗补助（Medicaid）患者（OR=0.85；95%CI：0.76-0.95；P=0.005）更不可能接受 SSRF。
接受 SSRF 的 45-64 岁和≥65 岁成年人之间未测量到临床结局的差异。老年患者不应被排除接受 SSRF。需要进一步努力改善黑人、西班牙裔和医疗补助患者的 SSRF 利用不足情况。
