Skip to main content

Advertisement

SpringerLink
Log in

Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

There is a general clinical consensus that early surgical stabilization of rib fractures (SSRF, ≤ 48–72 h after admission) can benefit patients, and this is only regarding the surgeon’s opinions. This study assessed the true outcomes of young and middle-aged patients at different surgical timings.

Methods

This retrospective cohort study was conducted among patients aged 30–55 years who were hospitalized with a diagnosis of isolated rib fractures and underwent SSRF between July 2017 and September 2021. The patients were divided into early (≤ 3 days), mid- (4–7 days) and late (8–14 days) groups, according to the interval (days) between surgery and injury date. The impact of different surgical timings on clinical outcomes, patients, and families was assessed by comparing SSRF-related data during hospitalization and follow-up studies of clinicians, patients themselves, and family caregivers 1–2 months after surgery.

Results

In this study, 155 complete patient data were finally included, including 52, 64, and 39 patients in the early, mid, and late groups, respectively. Length of operation, preoperative closed chest drainage rate, length of hospital stay, intensive care unit length of stay, duration of invasive mechanical ventilation in the early group were lower than those in the intermediate and late groups. Additionally, hemothorax and excess pleural fluid incidence after SSRF was lower in the early group than in the intermediate and late groups. Postoperative follow-up results showed that patients in the early group had higher SF-12 physical component summary scores and shorter duration of absence from work. Family caregivers had lower Zarit Burden Interview scores than those in the mid- and late groups.

Conclusion

From the experience of our institution's SSRF, early surgery is safe and offers additional potential benefits for young and middle-aged patients and families with isolated rib fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Abbreviations

SSRF:

Surgical stabilization of rib fractures

VAS:

Visual analogue scale

ABT:

Allogeneic blood transfusion

IMV:

Invasive mechanical ventilation

ICU:

Intensive care unit

CT:

Computed tomography

POM 1:

Post-operative 1 month

POM 2:

Post-operative 2 month

ZBI:

Zarit Burden Interview

PCS:

Physical component summary

MCS:

Mental component summary

ERAS:

Enhanced recovery after surgery

References

  1. Hofman M, Andruszkow H, Kobbe P, Poeze M, Hildebrand F. Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma. Eur J Trauma Emerg Surg. 2020;46(1):11–9.

    Article  PubMed  Google Scholar 

  2. Kong LW, Huang GB, Yi YF, Du DY. The Chinese consensus for surgical treatment of traumatic rib fractures 2021 (C-STTRF 2021). Chin J Traumatol. 2021;24(6):311–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shelat VG, Eileen S, John L, Teo LT, Vijayan A, Chiu MT. Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012;38(4):451–5.

    Article  CAS  PubMed  Google Scholar 

  4. Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46(1):61–5.

    Article  PubMed  Google Scholar 

  5. Choi J, Khan S, Sheira D, Hakes NA, Aboukhater L, Spain DA. Prospective study of long-term quality-of-life after rib fractures. Surgery. 2021;172:404.

    Article  PubMed  Google Scholar 

  6. Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017;48(2):307–21.

    Article  PubMed  Google Scholar 

  7. Kane ED, Jeremitsky E, Pieracci FM, Majercik S, Doben AR. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83(6):1047–52.

    Article  PubMed  Google Scholar 

  8. Otaka S, Aso S, Matsui H, Fushimi K, Yasunaga H. Early versus late rib fixation in patients with traumatic rib fractures: a nationwide study. Ann Thorac Surg. 2020;110(3):988–92.

    Article  PubMed  Google Scholar 

  9. Choi J, Kaghazchi A, Dickerson KL, Tennakoon L, Spain DA, Forrester JD. Heterogeneity in managing rib fractures across non-trauma and level I, II, and III trauma centers. Am J Surg. 2021;222(4):849–54.

    Article  PubMed  Google Scholar 

  10. Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618–26.

    Article  PubMed  Google Scholar 

  11. Marasco SF, Martin K, Niggemeyer L, Summerhayes R, Fitzgerald M, Bailey M. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury. 2019;50(1):119–24.

    Article  PubMed  Google Scholar 

  12. Émond M, Sirois MJ, Guimont C, et al. Functional impact of a minor thoracic injury: an investigation of age, delayed hemothorax, and rib fracture effects. Ann Surg. 2015;262(6):1115–22.

    Article  PubMed  Google Scholar 

  13. Xiao P, Zhou Y. Factors associated with the burden of family caregivers of elderly patients with femoral neck fracture: a cross-sectional study. J Orthop Surg Res. 2020;15(1):234.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ali-Osman F, Mangram A, Sucher J, et al. Geriatric (G60) trauma patients with severe rib fractures: is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function? Am J Surg. 2018;216(1):46–51.

    Article  PubMed  Google Scholar 

  15. Langenbach A, Oppel P, Grupp S, et al. Reduced invasive and muscle-sparing operative approaches to the posterolateral chest wall provide an excellent accessibility for the operative stabilization!: minimized approaches to the posterolateral chest wall. Eur J Trauma Emerg Surg. 2018;44(3):471–81.

    Article  CAS  PubMed  Google Scholar 

  16. Hasenboehler EA, Bernard AC, Bottiggi AJ, et al. Treatment of traumatic flail chest with muscular sparing open reduction and internal fixation: description of a surgical technique. J Trauma. 2011;71(2):494–501.

    PubMed  Google Scholar 

  17. Choi J, Mulaney B, Laohavinij W, et al. Nationwide cost-effectiveness analysis of surgical stabilization of rib fractures by flail chest status and age groups. J Trauma Acute Care Surg. 2021;90(3):451–8.

    Article  PubMed  Google Scholar 

  18. Kane ED, Jeremitsky E, Bittner KR, Kartiko S, Doben AR. Surgical stabilization of rib fractures: a single institution experience. J Am Coll Surg. 2018;226(6):961–6.

    Article  PubMed  Google Scholar 

  19. Majercik S, Wilson E, Gardner S, Granger S, VanBoerum DH, White TW. In-hospital outcomes and costs of surgical stabilization versus nonoperative management of severe rib fractures. J Trauma Acute Care Surg. 2015;79(4):533–8.

    Article  PubMed  Google Scholar 

  20. Aalberg JJ, Johnson BP, Hojman HM, et al. Readmission following surgical stabilization of rib fractures: analysis of incidence, cost, and risk factors using the Nationwide Readmissions Database. J Trauma Acute Care Surg. 2021;91(2):361–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yeates EO, Grigorian A, Nahmias J, et al. Isolated thoracic injury patients with rib fractures undergoing rib fixation have improved mortality. J Surg Res. 2021;262:197–202.

    Article  PubMed  Google Scholar 

  22. Pieracci FM, Leasia K, Bauman Z, et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 2020;88(2):249–57.

    Article  PubMed  Google Scholar 

  23. Chen Zhu R, de Roulet A, Ogami T, Khariton K. Rib fixation in geriatric trauma: mortality benefits for the most vulnerable patients. J Trauma Acute Care Surg. 2020;89(1):103–10.

    Article  CAS  PubMed  Google Scholar 

  24. Su YH, Yang SM, Huang CH, Ko HJ. Early versus late surgical stabilization of severe rib fractures in patients with respiratory failure: a retrospective study. PLoS ONE. 2019;14(4): e0216170.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Librero J, Peiró S, Leutscher E, et al. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System. BMC Health Serv Res. 2012;12:15.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Prins JTH, Wijffels MME, Pieracci FM. What is the optimal timing to perform surgical stabilization of rib fractures? J Thorac Dis. 2021;13(Suppl 1):S13-s25.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pieracci FM, Coleman J, Ali-Osman F, et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2018;84(1):1–10.

    Article  PubMed  Google Scholar 

  28. Harrell KN, Jean RJ, Dave Bhattacharya S, Hunt DJ, Barker DE, Maxwell RA. Late operative rib fixation is inferior to nonoperative management. Am Surg. 2020;86(8):944–9.

    Article  PubMed  Google Scholar 

  29. Otaka S, Aso S, Matsui H, Fushimi K, Yasunaga H. Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study. Eur J Trauma Emerg Surg. 2022;48(2):1501–8.

    Article  PubMed  Google Scholar 

  30. Pieracci FM, Leasia K, Hernandez MC, et al. Surgical stabilization of rib fractures in octogenarians and beyond-what are the outcomes? J Trauma Acute Care Surg. 2021;90(6):1014–21.

    Article  CAS  PubMed  Google Scholar 

  31. Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201–5.

    Article  PubMed  Google Scholar 

  32. Wang Z, Lu Y, Sun L, et al. Do the successful revision surgery for humeral nonunion solve all the effects on health-related quality of life? A retrospective cohort study. BMC Musculoskelet Disord. 2021;22(1):414.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Baker E, Xyrichis A, Norton C, Hopkins P, Lee G. The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review. Scand J Trauma Resusc Emerg Med. 2018;26(1):67.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Claydon J, Maniatopoulos G, Robinson L, Fearon P. Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study. Disabil Rehabil. 2018;40(23):2780–9.

    Article  PubMed  Google Scholar 

  35. Qiu M, Shi Z, Xiao J, Zhang X, Ling S, Ling H. Potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures. Indian J Surg. 2016;78(6):458–63.

    Article  PubMed  Google Scholar 

  36. Li C, Miao J, Gao X, et al. Factors associated with caregiver burden in primary caregivers of patients with adolescent scoliosis: a descriptive cross-sectional study. Med Sci Monit. 2018;24:6472–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sarode AL, Ho VP, Pieracci FM, Moorman ML, Towe CW. The financial burden of rib fractures: National estimates 2007 to 2016. Injury. 2021;52(8):2180–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Luo J, Zhou Y, Liu H, Hu J. Factors related to the burden of family caregivers of elderly patients with spinal tumours in Northwest China. BMC Neurol. 2020;20(1):69.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Haslam SA, Haslam C, Jetten J, Cruwys T, Bentley SV. Rethinking the nature of the person at the heart of the biopsychosocial model: exploring social changeways not just personal pathways. Soc Sci Med. 1982;2021(272): 113566.

    Google Scholar 

  40. Clay FJ, Newstead SV, Watson WL, McClure RJ. Determinants of return to work following non life threatening acute orthopaedic trauma: a prospective cohort study. J Rehabil Med. 2010;42(2):162–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Shaanxi Province Science and Technology Department (No. 2017ZDXM-SF-009).

Funding

This study was supported by the Shaanxi Province Science and Technology Department (No. 2017ZDXM-SF-009).

Author information

Author notes

  1. Zhimeng Wang and Gang Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710000, Shaanxi, China

    Zhimeng Wang, Gang Wang, Baoli Jing, Shanghua Feng, Shaobo Zhang, Dinghua Wu, Zhe Song, Lin Niu & Bin Qi

Authors
  1. Zhimeng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Baoli Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shanghua Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shaobo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dinghua Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhe Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lin Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bin Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BQ and WZM were responsible for the study design, the definition of intellectual content, and for literature research. WZM and WG analyzed and interpreted data. SZ and JBL performed the statistical analysis. ZMW, FSH and WDH drafted the manuscript. ZSB, NL and BQ revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bin Qi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Approval was obtained from the Clinical Trials and Biomedical Ethics Committee of Hong Hui Hospital (Approval Number: 201606008), and written informed consent was obtained from all participants. All authors confirmed that all methods were performed in accordance with the relevant guidelines and regulations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Z., Wang, G., Jing, B. et al. Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers. Eur J Trauma Emerg Surg 49, 2467–2477 (2023). https://doi.org/10.1007/s00068-023-02321-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-023-02321-w

Keywords

Search

Navigation