Knoef, R.J.H. (2017) Optimal treatment of multiple rib fractures. An analysis of surgical versus conservativemanagement in the elderly patient. thesis, Medicine.
Full text available on request.Abstract
Background Open reduction and internal fixation (ORIF) of fractured ribs may be an underused procedure as multiple studies have reported positive effects of operative treatment after chest trauma. However, only one trial focused on the fragile elderly with rib fractures, a patient group of great clinical relevance to this type of injury because of high morbidity and mortality. As the ageing population might greatly benefit from early rib fixation over conventional treatment we compared ORIF with conservative management in the elderly patient the multiple rib fractures. Methods This retrospective control study compares ORIF with conservative management of patients (n=172) age ≥55 with multiple rib fractures admitted from 2011-2016. The operative group (n=13) was matched to controls (n=159) based on age and abbreviated injury severity scores. Additional subgroup analysis of flail chest patients (n=30) was performed. Primary outcome variables included duration of hospital days (DHS), duration of intensive care unit (ICU) stay and duration of invasive mechanical ventilation (DMV). Secondary outcome measures were: incidence of pneumonia, mortality and Glasgow Outcome Score (GOS). Results Results favored the nonoperative treatment, however multivariate analysis presented no significant differences in DHS (median days [IQR], 14 [12 - 24] vs 8 [3 - 14], p = 0.17), ICU stay (median days [IQR], 5 [3 - 17] vs 3 [1 - 5], p = 0.06) or DMV (median days [IQR], 5 [2 - 17] vs 3 [1 - 20], p = 0.55) between the intervention groups. Pneumonia rates (OR [95% CI] 1.21 [0.28 - 5.15], p = 0.80), mortality (OR [95% CI] 3.50 [0.81 - 15.07], p = 0.09) and GOS (OR [95% CI] 1.99 [0.54 - 7.43], p = 0.30) also were not significantly disparate for both groups. All findings were consistent in subgroup analysis of flail chest patients. Conclusions Open reduction and internal fixation as treatment of multiple rib fractures in the elderly (age ≥55) patient does not demonstrate a meaningful decrease in total hospital days, ICU stay, IMV duration, pneumonia rates, mortality or GOS. We can thus conclude that the population of elderly patients with multiple rib fractures does not gain additional benefits from early surgical intervention over conservative management. With surgical expenditures outweighing the costs of conservative therapy we cannot justify recommending operative treatment as the primary intervention in this select group of patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Vugt, Prof. Dr. A.B. van and Medisch Spectrum Twente, Department of Surgery |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1184 |
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