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VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases

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Abstract

Objectives

Early surgical stabilization of flail chest has been shown to improve chest wall stability and diminish respiratory complications. The addition of video‑assisted thoracoscopic surgery (VATS) can diagnose and manage intrathoracic injuries and evacuate hemothorax. This study analyzed the outcome of our 7-year experience with VATS-assisted surgical stabilization of rib fractures (SSRF) for flail chest.

Methods

From January 2013 to December 2019, all trauma patients undergoing VATS-assisted SSRF for flail chest were included. Patient characteristics and complications during 1-year follow-up were reported.

Results

VATS‑assisted SSRF for flail chest was performed in 105 patients. Median age was 65 years (range 21–92). Median injury severity score was 16 (range 9–49). Hemothorax was evacuated with VATS in 80 patients (median volume 200 ml, range 25–2500). In 3 patients entrapped lung was freed from the fracture site and in 2 patients a diaphragm rupture was repaired. Median postoperative ICU admission was 2 days (range 1–41). Thirty-two patients (30%) had a post‑operative complication during admission and six patients (6%) a complication within 1 year. In-hospital mortality rate was 1%. Six patients (6%) died after discharge, due to causes unrelated to the original injury.

Conclusions

Addition of VATS to SSRF for flail chest seems helpful to diagnose and manage intrathoracic injuries and adequately evacuate hemothorax. The majority of complications are low grade and occur during admission. Further prospective research needs to be conducted to identify potential risk factors for complications and better selection for addition of VATS to improve care in the future.

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Authors and Affiliations

  1. Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands

    Matthijs H. van Gool, Lori M. van Roozendaal, Yvonne L. J. Vissers, Robert van den Broek, Raoul van Vugt, Berend Meesters, Annette M. Pijnenburg, Karel W. E. Hulsewé & Erik R. de Loos

Authors
  1. Matthijs H. van Gool
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  2. Lori M. van Roozendaal
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  3. Yvonne L. J. Vissers
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  4. Robert van den Broek
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  5. Raoul van Vugt
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  6. Berend Meesters
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  7. Annette M. Pijnenburg
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  8. Karel W. E. Hulsewé
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  9. Erik R. de Loos
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Contributions

All authors contributed to study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision of manuscript.

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Correspondence to Erik R. de Loos.

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van Gool, M.H., van Roozendaal, L.M., Vissers, Y.L.J. et al. VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases. Gen Thorac Cardiovasc Surg 70, 985–992 (2022). https://doi.org/10.1007/s11748-022-01830-6

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  • DOI: https://doi.org/10.1007/s11748-022-01830-6

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