Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI)

Jonne T.H. Prins, Esther M.M. Van Lieshout, Francis Ali-Osman, Zachary M. Bauman, Eva Corina Caragounis, Jeff Choi, D. Benjamin Christie, Peter A. Cole, William B. DeVoe, Andrew R. Doben, Evert A. Eriksson, Joseph D. Forrester, Douglas R. Fraser, Brendan Gontarz, Claire Hardman, Daniel G. Hyatt, Adam J. Kaye, Huan Jang Ko, Kiara N. Leasia, Stuart LeonSilvana F. Marasco, Allison G. McNickle, Timothy Nowack, Temi D. Ogunleye, Prakash Priya, Aaron P. Richman, Victoria Schlanser, Gregory R. Semon, Ying Hao Su, Michael H.J. Verhofstad, Julie Whitis, Fredric M. Pieracci, Mathieu M.E. Wijffels

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

BACKGROUND: Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI. METHODS: A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS score, 9–12) and severe (GCS score, ≤8) TBI. RESULTS: The study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. The SSRF was performed at a median of 3 days, and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.38–0.98; p = 0.043) and 30-day mortality (OR, 0.32; 95% CI, 0.11–0.91; p = 0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (OR, 0.19; 95% CI, 0.04–0.88; p = 0.034). CONCLUSION: In patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI.

Original languageEnglish (US)
Pages (from-to)492-500
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume90
Issue number3
DOIs
StatePublished - Mar 2021

Bibliographical note

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Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Outcome
  • rib fractures
  • surgical stabilization of rib fractures
  • thoracic trauma
  • traumatic brain injury

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