Dysrhythmia in traumatic RIB Fixation

Abstract

IntroductionThe fixation of traumatic rib fractures with metallic plates has multiple benefits, especially in flail segments. These include reducing the number of ventilated and ICU days, the need for a tracheostomy, reduced incidence of pneumonia, and overall improvement in pain [1]. While the benefits have been defined, there have been a paucity of data in the reported medical risks of the procedure. At our institution, an anecdotally observed complication following the procedure included cardiac arrhythmia.MethodsA retrospective review of all patients sustaining acutely traumatic rib fractures undergoing operative fixation over a five-year period from March of 2015 to March of 2020 were included. A total of fifteen patients met criteria. All patients were confirmed to be in normal sinus rhythm preoperatively. Postoperatively, all patients were sent to the surgical ICU and continuously monitored for arrhythmia via telemetry. All arrhythmias identified were confirmed via twelve-lead electrocardiograms (EKG).ResultsNo patients had a history of arrhythmia preoperatively. Of the 15 patients, 11 (73%) [95% CI: 45-92%] were confirmed to have any arrhythmia postoperatively [Table 1]. Excluding sinus tachycardia, which may be attributable to a number of other perioperative factors, 8 (53%) patients [95% CI: 26-78%] were found to have experienced another arrhythmia as described above [Table 1].DiscussionThese results show that rib fixation carries a significant risk for perioperative cardiac dysrhythmia. Historical controls show the incidence of arrhythmia in non-cardiac, thoracic surgery to be between 17-30%, with atrial fibrillation accounting for the majority [2,3,4,5]. The total incidence of any arrhythmia after rib plating was 73%, which is significantly higher than the upper boundary (30%) of historical norms (p=0.0003) [Table 2]. Excluding sinus tachycardia, the incidence drops to 53% for rib plating, which still remains elevated above historical controls (p=0.05) [Table 2]. Multiple studies in cardiac surgery have proven preoperative antiarrhythmics effective in providing arrhythmia prophylaxis. Further investigation should be performed in arrhythmia prophylaxis in rib fixation. The fixation of traumatic rib fractures with metallic plates has multiple benefits, especially in flail segments. These include reducing the number of ventilated and ICU days, the need for a tracheostomy, reduced incidence of pneumonia, and overall improvement in pain [1]. While the benefits have been defined, there have been a paucity of data in the reported medical risks of the procedure. At our institution, an anecdotally observed complication following the procedure included cardiac arrhythmia. A retrospective review of all patients sustaining acutely traumatic rib fractures undergoing operative fixation over a five-year period from March of 2015 to March of 2020 were included. A total of fifteen patients met criteria. All patients were confirmed to be in normal sinus rhythm preoperatively. Postoperatively, all patients were sent to the surgical ICU and continuously monitored for arrhythmia via telemetry. All arrhythmias identified were confirmed via twelve-lead electrocardiograms (EKG). No patients had a history of arrhythmia preoperatively. Of the 15 patients, 11 (73%) [95% CI: 45-92%] were confirmed to have any arrhythmia postoperatively [Table 1]. Excluding sinus tachycardia, which may be attributable to a number of other perioperative factors, 8 (53%) patients [95% CI: 26-78%] were found to have experienced another arrhythmia as described above [Table 1]. These results show that rib fixation carries a significant risk for perioperative cardiac dysrhythmia. Historical controls show the incidence of arrhythmia in non-cardiac, thoracic surgery to be between 17-30%, with atrial fibrillation accounting for the majority [2,3,4,5]. The total incidence of any arrhythmia after rib plating was 73%, which is significantly higher than the upper boundary (30%) of historical norms (p=0.0003) [Table 2]. Excluding sinus tachycardia, the incidence drops to 53% for rib plating, which still remains elevated above historical controls (p=0.05) [Table 2]. Multiple studies in cardiac surgery have proven preoperative antiarrhythmics effective in providing arrhythmia prophylaxis. Further investigation should be performed in arrhythmia prophylaxis in rib fixation.