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European Journal of Trauma and Emergency Surgery

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01-08-2020 | Rib Fracture | Original Article

Smoking is associated with an improved short-term outcome in patients with rib fractures

Authors: Areg Grigorian, Michael Lekawa, Matthew Dolich, Sebastian D. Schubl, Andrew R. Doben, Catherine M. Kuza, Cristobal Barrios, Jeffry Nahmias

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2020

Abstract

Background

Smokers with cardiovascular disease have been reported to have decreased mortality compared to non-smokers. Rib fractures are associated with significant underlying injuries such as lung contusions, lacerations, and/or pneumothoraces. We hypothesized that blunt trauma patients with rib fractures who are smokers have decreased ventilator days and risk of in-hospital mortality compared to non-smokers.

Study design

The Trauma Quality Improvement Program (2010–2016) was queried for patients presenting with a blunt rib fracture. Patients that died within 24 h of admission were excluded. A multivariable logistic regression model was performed.

Results

From 282,986 patients with rib fractures, 57,619 (20.4%) were smokers. Compared to non-smokers with rib fractures, smokers had a higher median injury severity score (17 vs. 16, p < 0.001). Smokers had a higher rate of pneumonia (7.5% vs. 6.6%, p < 0.001), however, less ventilator days (5 vs. 6, p = 0.04), and lower in-hospital mortality rate (2.3% vs. 4.6%, p < 0.001), compared to non-smokers. After controlling for covariates, smokers with rib fractures were associated with a decreased risk for in-hospital mortality compared to non-smokers with rib fractures (OR 0.64, 0.56–0.73, p < 0.001).

Conclusion

Despite having more severe injuries and increased rates of pneumonia, smokers with rib fractures were associated with nearly a 40% decreased risk of in-hospital mortality and one less ventilator day compared to non-smokers. The long-term detrimental effects of smoking have been widely established. However, the biologic and pathophysiologic adaptations that smokers have may confer a survival benefit when recovering in the hospital from chest wall trauma. This study was limited by the database missing the number of pack-years smoked. Future prospective studies are needed to confirm this association and elucidate the physiologic mechanisms that may explain these findings.

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Title: Smoking is associated with an improved short-term outcome in patients with rib fractures
Authors: Areg Grigorian
Michael Lekawa
Matthew Dolich
Sebastian D. Schubl
Andrew R. Doben
Catherine M. Kuza
Cristobal Barrios
Jeffry Nahmias
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Rib Fracture
Pneumonia
Acute Respiratory Distress-Syndrome
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01152-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Smoking is associated with an improved short-term outcome in patients with rib fractures

Abstract

Background

Study design

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Study design

Results

Conclusion

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