Reference : Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective O...

	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Surgery
	To cite this reference:	http://hdl.handle.net/10993/42717

Title :	Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study
Language :	English
Author, co-author :	Olland, Anne [Nouvel Hôpital Civil, University Hospital Strasbourg, France > Thoracic Surgery Department]
	Puyraveau, Marc [University Hospital Besançon, Besançon, France > Clinical Methodology Center]
	Guinard, Sophie [Nouvel Hôpital Civil, University Hospital Strasbourg, France > Thoracic Surgery Department]
	Seitlinger, Joseph [Nouvel Hôpital Civil', University Hospital Strasbourg, France > Thoracic Surgery Department > > ; INSERM (French National Institute of Health and Medical Research) UMR 1260 > Regenerative Nanomedicine (RNM)]
	Kadoche, Déborah [Nouvel Hôpital Civil, University Hospital Strasbourg, France > Thoracic Surgery Department]
	Perrier, Stéphanie [Nouvel Hôpital Civil, University Hospital Strasbourg, France > Thoracic Surgery Department]
	Renaud, Stéphane [Nouvel Hôpital Civil', University Hospital Strasbourg, France > Thoracic Surgery Department]
	Falcoz, Pierre-Emmanuel [Nouvel Hôpital Civil', University Hospital Strasbourg, France > Thoracic Surgery Department > > ; INSERM (French National Institute of Health and Medical Research) UMR 1260 > Regenerative Nanomedicine (RNM)]
	Massard, Gilbert [University of Luxembourg > Faculty of Science, Technology and Communication (FSTC) > > ; Nouvel Hôpital Civil, University Hospital Strasbourg, France > Thoracic Surgery Department > > ; INSERM (French National Institute of Health and Medical Research) UMR 1260 > Regenerative Nanomedicine (RNM)]
Publication date :	2019
Journal title :	Journal of Thoracic Disease
Publisher :	AME Publications
Peer reviewed :	Yes (verified by ORBilu)
Audience :	International
ISSN :	2072-1439
e-ISSN :	2077-6624
City :	Hong Kong
Country :	China
Keywords :	[en] Thoracic trauma ; flail chest ; multiple rib fractures ; surgery ; osteosynthesis
Abstract :	[en] Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization.
Target :	Researchers ; Professionals
Permalink :	http://hdl.handle.net/10993/42717
DOI :	10.21037/jtd.2018.10.122

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