Surgical stabilization of rib fractures: The impact of volume and the need for standardized indications

Abstract

IntroductionWe aimed to examine impact of trauma center (TC) surgical stabilization of rib fracture (SSRF) volume on outcomes of patients undergoing SSRF. MethodsBlunt rib fracture patients who underwent SSRF were included from ACS-TQIP2017-2021. TCs were stratified according to tertiles of SSRF volume:low (LV), middle, and high (HV). Outcomes were time to SSRF, respiratory complications, prolonged ventilator use, mortality. Results16,872 patients were identified (LV:5470,HV:5836). Mean age was 56 years, 74% were male, median thorax-AIS was 3. HV centers had a lower proportion of patients with flail chest (HV41% vs LV50%), pulmonary contusion (HV44% vs LV52%) and had shorter time to SSRF(HV58 vs LV76 ​h), less respiratory complications (HV3.2% vs LV4.5%), prolonged ventilator use (HV15% vs LV26%), mortality (HV2% vs LV2.6%) (all p ​< ​0.05). On multivariable regression analysis, HV centers were independently associated with reduced time to SSRF(β ​= ​−18.77,95%CI ​= ​−21.30to-16.25), respiratory complications (OR ​= ​0.67,95%CI ​= ​0.49–0.94), prolonged ventilator use (OR ​= ​0.49,95%CI ​= ​0.41–0.59), but not mortality. ConclusionsHV SSRF centers have improved outcomes, however, there are variations in threshold for SSRF and indications must be standardized. Level of evidenceLevel III. Study typeTherapeutic/Care Management.