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;302:517-524. doi: 10.1016/j.jss.2024.07.101. Epub 2024 Aug 22.
Surgical stabilization of rib fractures (SSRF) has been associated with lower rates of mortality and fewer respiratory complications. This study sought to evaluate the association between SSRF timing and patient outcomes.
This retrospective analysis included patients aged ≥45 y who underwent SSRF in the Trauma Quality Improvement Program database from 2016 to 2020. Primary outcome was incidence of ventilator-assisted pneumonia (VAP). Secondary outcomes included acute respiratory distress syndrome (ARDS), unplanned endotracheal intubation, in-hospital mortality, failure to rescue (FTR) after all major complications, and FTR after severe respiratory complications. Logistic regression models of outcomes on timing to SSRF were fit while controlling for age, gender, body mass index, injury severity score, flail chest, chronic obstructive pulmonary disease, congestive heart failure, and smoking.
Among 4667 patients who received SSRF, average time to SSRF was 4.6 ± 3.2 d. Each additional day to SSRF was associated with increased odds of VAP (odds ratio [OR] 1.07, confidence interval [CI] 1.03-1.11) and intubation (OR 1.10, CI 1.08-1.13). A longer time to SSRF was associated with increased odds of ARDS (OR 1.10, CI 1.05-1.15), while no significant association was observed for in-hospital mortality (OR 0.99, CI 0.93-1.04). A longer time to SSRF was associated with decreased odds of FTR after a major complication (OR 0.90, CI 0.83-0.97) and respiratory complications (OR 0.87, CI 0.78-0.96).
For each day that SSRF is delayed, increased odds of VAP, intubation, and ARDS were observed. Prompt intervention is crucial for preventing these complications and improving our ability to rescue patients.
外科固定肋骨骨折（SSRF）与死亡率降低和呼吸并发症减少相关。本研究旨在评估 SSRF 时机与患者结局之间的关联。
本回顾性分析纳入了 2016 年至 2020 年在创伤质量改进计划数据库中接受 SSRF 的年龄≥45 岁的患者。主要结局为呼吸机相关性肺炎（VAP）发生率。次要结局包括急性呼吸窘迫综合征（ARDS）、计划性气管插管、院内死亡率、所有主要并发症后抢救失败（FTR）以及严重呼吸并发症后 FTR。在控制年龄、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的情况下，拟合了结局与 SSRF 时机的逻辑回归模型。
在接受 SSRF 的 4667 例患者中，平均 SSRF 时间为 4.6±3.2 天。每延迟一天 SSRF，VAP（比值比 [OR] 1.07，置信区间 [CI] 1.03-1.11）和插管（OR 1.10，CI 1.08-1.13）的可能性就会增加。SSR 时间延长与 ARDS（OR 1.10，CI 1.05-1.15）的可能性增加相关，而院内死亡率（OR 0.99，CI 0.93-1.04）没有显著相关性。SSR 时间延长与主要并发症（OR 0.90，CI 0.83-0.97）和呼吸并发症（OR 0.87，CI 0.78-0.96）后抢救失败的可能性降低相关。
每延迟一天 SSRF，VAP、插管和 ARDS 的可能性就会增加。及时干预对于预防这些并发症和提高抢救患者的能力至关重要。
