Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: A propensity score-matched analysis.
OBJECTIVE
We investigated whether surgical rib fixation improved outcomes in patients with traumatic rib fractures.


METHODS
This was a retrospective study using a Japanese administrative claim and discharge database. We included patients with traumatic rib fractures admitted to hospitals where surgical rib fixation was available from July 1 2010, to March 31, 2013. We detected patients who underwent surgical rib fixation within 10 days of hospital admission (surgical group) and those who did not (control group). The main outcome was prolonged mechanical ventilation, defined as that performed for 5 or more days, or death within 28 days. One-to-four propensity score matching was performed between the 2 groups with adjustment for possible confounders.


RESULTS
Among 4577 eligible patients, 90 (2.0%) underwent the surgical rib fixation. After the matching, we obtained 84 and 336 patients in the surgical and control groups, respectively. Logistic regression analyses showed that the surgical group was significantly less likely to receive prolonged mechanical ventilation or die within 28 days than the control group (22.6% vs 33.3%; odds ratio, 0.59; 95% confidence interval, 0.36-0.96; P=.034).


CONCLUSIONS
Surgical rib fixation within 10 days of hospital admission may improve outcomes in patients with traumatic rib fractures.
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: wadat-eme@h.u-tokyo.ac.jp.
Tomoki
T
Wada
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Hideo
H
Yasunaga
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Ryota
R
Inokuchi
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Hiroki
H
Matsui
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Takehiro
T
Matsubara
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Yoshihiro
Y
Ueda
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Masataka
M
Gunshin
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Takeshi
T
Ishii
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Kent
K
Doi
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Yoichi
Y
Kitsuta
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Susumu
S
Nakajima
Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
Kiyohide
K
Fushimi
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Naoki
N
Yahagi
D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012253:Rib Fractures / Q000601:surgery*; D055815:Young Adult
Cohort study; Diagnosis Procedure Combination database; Propensity score matching; Surgical rib fixation; Survival analysis; Traumatic rib fracture