Is Severe Traumatic Brain Injury no Longer a Contra-Indication for Surgical Stabilization of Rib Fractures in Patients with Multiple Rib Fractures? A Propensity-Matched Analysis.

Abstract

Traumatic brain injury (TBI) is often considered a contraindication to surgical stabilization of rib fractures (SSRF). In this study, we hypothesized that compared to non-operative management, SSRF is associated with improved outcomes in TBI patients. Using the ACS-TQIP 2016-2019, we performed a retrospective analysis of patients with concurrent TBI and multiple rib fractures. Following propensity score matching, we compared patients who underwent SSRF with those who were managed nonoperatively. Our primary outcome was mortality. Secondary outcomes included ventilator-associated pneumonia (VAP), hospital and intensive care unit (ICU) length of stay (LOS), ventilator days, tracheostomy rate, and hospital discharge disposition. In a subgroup analysis, we stratified patients into mild and moderate TBI (GCS >8) and severe TBI (GCS ≤ 8). Out of 36,088 patients included in this study, 879 (2.4%) underwent SSRF. After propensity-score matching, compared with non-operative management, SSRF was associated with decreased mortality (5.4% vs. 14.5%,p < .001), increased hospital LOS (15 days vs. 9 days,p < .001), increased ICU LOS (12 days vs. 8 days,p < .001) and increased ventilator days (7 days vs. 4 days,p < .001). In the subgroup analyses, in mild and moderate TBI SSRF was associated with decreased in-hospital mortality (5.0% vs. 9.9%,p = .006), increased hospital LOS (13 days vs. 9 days,p < .001), ICU LOS (10 days vs. 7 days,p < .001), and ventilator days (5 days vs. 2 days, p < .001). In patients with severe TBI, SSRF was associated with decreased mortality (6.2% vs. 18%,p < .001), increased hospital LOS (20 days vs. 14 days,p = .001), and increased ICU LOS (16 days vs. 13 days,p = .004). In patients with TBI and multiple rib fractures, SSRF is associated with a significant decrease in in-hospital mortality and with longer hospital and ICU lengths of stay. These findings suggest that SSRF should be considered in patients with TBI and multiple rib fractures. Level IV, Therapeutic.