Aryan Negaar, Nahmias Jeffry, Grigorian Areg, Hsiao Zoe, Bhullar Avneet, Dolich Matthew, Jebbia Mallory, Patel Falak, Hemingway Jacquelyn, Silver Elliot, Schubl Sebastian
University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care.
Injury. 2025 Jan;56(1):111910. doi: 10.1016/j.injury.2024.111910. Epub 2024 Sep 24.
Surgical stabilization of rib fractures (SSRF) has been demonstrated to improve early clinical outcomes. Tube thoracostomy (TT) is commonly performed with SSRF, however there is a paucity of data regarding when removal of TT following SSRF should occur. This study aimed to compare patients undergoing thoracic reinterventions (reintubation, reinsertion of TT/pigtail, or video-assisted thoracic surgery) to those not following SSRF+TT, hypothesizing increased TT output prior to removal would be associated with thoracic reintervention.
We performed a single center retrospective (2018-2023) analysis of blunt trauma patients ≥ 18 years-old undergoing SSRF+TT. The primary outcome was thoracic reinterventions. Patients undergoing thoracic reintervention ((+)thoracic reinterventions) after TT removal were compared to those who did not ((-)thoracic reintervention). Secondary outcomes included TT duration and outputs prior to removal.
From 133 blunt trauma patients undergoing SSRF+TT, 23 (17.3 %) required thoracic reinterventions. Both groups were of comparable age. The (+)thoracic reintervention group had an increased injury severity score (median: 29 vs. 17, p = 0.035) and TT duration (median: 4 vs. 3 days, p < 0.001) following SSRF. However, there were no differences in median TT outputs between both cohorts post-SSRF day 1 (165 mL vs. 160 mL, p = 0.88) as well as within 24 h (60 mL vs. 70 mL, p = 0.93) prior to TT removal.
This study demonstrated over 17 % of SSRF+TT patients required a thoracic reintervention. There was no association between thoracic reintervention and the TT output prior to removal. Future studies are needed to confirm these findings, which suggest no absolute threshold for TT output should be utilized regarding when to pull TT following SSRF.
肋骨骨折的手术固定（SSRF）已被证明可改善早期临床结果。胸腔闭式引流术（TT）通常与SSRF一起进行，然而，关于SSRF后何时应拔除TT的数据很少。本研究旨在比较接受胸部再次干预（重新插管、重新插入TT/猪尾管或电视辅助胸腔手术）的患者与未接受SSRF+TT的患者，假设拔除前TT引流量增加与胸部再次干预有关。
我们对18岁及以上接受SSRF+TT的钝性创伤患者进行了单中心回顾性（2018 - 2023年）分析。主要结局是胸部再次干预。将TT拔除后接受胸部再次干预（（+）胸部再次干预）的患者与未接受（（-）胸部再次干预）的患者进行比较。次要结局包括TT持续时间和拔除前的引流量。
在133例接受SSRF+TT的钝性创伤患者中，23例（17.3%）需要进行胸部再次干预。两组年龄相当。（+）胸部再次干预组在SSRF后的损伤严重程度评分增加（中位数：29对17，p = 0.035），TT持续时间增加（中位数：4天对3天，p < 0.001）。然而，在SSRF后第1天，两个队列的TT引流量中位数无差异（165 mL对160 mL，p = 0.88），在TT拔除前24小时内也无差异（60 mL对70 mL，p = 0.93）。
本研究表明，超过17%的SSRF+TT患者需要进行胸部再次干预。胸部再次干预与拔除前TT引流量之间没有关联。需要进一步的研究来证实这些发现，这表明在SSRF后拔除TT时，不应使用绝对的TT引流量阈值。
