Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2022

Open Access 12-04-2021 | Rib Fracture | Original Article

Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

Authors: Jonne T. H. Prins, Mathieu M. E. Wijffels, Sophie M. Wooldrik, Martien J. M. Panneman, Michael H. J. Verhofstad, Esther M. M. Van Lieshout

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Login to get access

Abstract

Purpose

This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures.

Methods

A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire.

Results

In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age.

Conclusion

Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.
Literature
1.
Edgecombe L, Sigmon DF, Galuska MA, Angus LD. Thoracic Trauma. 2020.
2.
Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, Gamelli RL. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23.CrossRef
3.
Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.CrossRef
4.
Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43–6.PubMedPubMedCentral
5.
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–6.CrossRef
6.
Edwards JG, Clarke P, Pieracci FM, Bemelman M, Black EA, Doben A, Gasparri M, Gross R, Jun W, Long WB, et al. Taxonomy of multiple rib fractures: Results of the chest wall injury society international consensus survey. J Trauma Acute Care Surg. 2020;88(2):e40–5.CrossRef
7.
Coary R, Skerritt C, Carey A, Rudd S, Shipway D. New horizons in rib fracture management in the older adult. Age Ageing. 2020;49(2):161–7.CrossRef
8.
Cameron P, Dziukas L, Hadj A, Clark P, Hooper S. Rib fractures in major trauma. Aust N Z J Surg. 1996;66(8):530–4.CrossRef
9.
Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43(1):8–17.CrossRef
10.
Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J, Martin M. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.CrossRef
11.
Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003;196(4):549–55.CrossRef
12.
Van Vledder MG, Kwakernaak V, Hagenaars T, Van Lieshout EMM, Verhofstad MHJ, South West Netherlands Trauma Region Study G. Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study. Eur J Trauma Emerg Surg. 2019;45(4):575–83.
13.
Kerr-Valentic MA, Arthur M, Mullins RJ, Pearson TE, Mayberry JC. Rib fracture pain and disability: can we do better? J Trauma. 2003;54(6):1058–63.CrossRef
14.
Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg. 2013;205(5):511–5.CrossRef
15.
Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014;207(5):659–62.CrossRef
16.
Shelat VG, Eileen S, John L, Teo LT, Vijayan A, Chiu MT. Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012;38(4):451–5.CrossRef
17.
Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46(1):61–5.CrossRef
18.
Peek J, Beks RB, Hietbrink F, De Jong MB, Heng M, Beeres FJP, FFA IJ, Leenen LPH, Groenwold RHH, Houwert RM. Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands. Eur J Trauma Emerg Surg. 2020.
19.
Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA, Osteoporotic Fractures in Men Study G. Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study. BMJ. 2010;340:c1069.
20.
Palvanen M, Kannus P, Niemi S, Parkkari J. Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future. Osteoporos Int. 2004;15(8):649–53.CrossRef
21.
Meerding WJ, Polinder S, Lyons RA, Petridou ET, Toet H, van Beeck F, Mulder S. How adequate are emergency department home and leisure injury surveillance systems for cross-country comparisons in Europe? Int J Inj Contr Saf Promot. 2010;17(1):13–22.CrossRef
22.
Majercik S, Wilson E, Gardner S, Granger S, VanBoerum DH, White TW. In-hospital outcomes and costs of surgical stabilization versus nonoperative management of severe rib fractures. J Trauma Acute Care Surg. 2015;79(4):533–8.CrossRef
23.
Toet H, Blatter B, Panneman MJ, Wijnstok N, Sprik E. Letsel Informatie Systeem (LIS): Methoden en toepassingen. VeiligheidNL, 2019.
24.
Leliveld MS, Polinder S, Panneman MJM, Verhofstad MHJ, Van Lieshout EMM. Epidemiologic trends for isolated tibia shaft fracture admissions in The Netherlands between 1991 and 2012. Eur J Trauma Emerg Surg. 2020;46(5):1115–22.CrossRef
25.
26.
Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35(11):1095–108.CrossRef
27.
Polinder S, van Beeck EF, Essink-Bot ML, Toet H, Looman CW, Mulder S, Meerding WJ. Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands. J Trauma. 2007;62(1):133–41.CrossRef
28.
Meerding WJ, Mulder S, van Beeck EF. Incidence and costs of injuries in The Netherlands. Eur J Public Health. 2006;16(3):272–8.CrossRef
29.
Meerding WJ BE, Mulder S. Costs of injury in the Netherlands. Amsterdam. Consumer Safety Institute. 2000;79.
30.
de Putter CE, Selles RW, Polinder S, Panneman MJ, Hovius SE, van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am. 2012;94(9):e56.CrossRef
31.
Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.CrossRef
32.
Mahabier KC, Hartog DD, Van Veldhuizen J, Panneman MJ, Polinder S, Verhofstad MH, Van Lieshout EM. Trends in incidence rate, health care consumption, and costs for patients admitted with a humeral fracture in The Netherlands between 1986 and 2012. Injury. 2015;46(10):1930–7.CrossRef
33.
Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, Adams C Jr, Daniels AH, Eltorai AEM. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury. 2019;50(6):1159–65.CrossRef
34.
De Boer AS, Schepers T, Panneman MJ, Van Beeck EF, Van Lieshout EM. Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986–2010. BMC Musculoskelet Disord. 2014;15:128.CrossRef
35.
Peek J, Ochen Y, Saillant N, Groenwold RHH, Leenen LPH, Uribe-Leitz T, Houwert RM, Heng M. Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank. Trauma Surg Acute Care Open. 2020;5(1):e000441.
36.
Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma. 1984;24(5):410–4.CrossRef
37.
Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA, IOF EURPo. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8:137.
38.
Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32.PubMed
39.
Swart E, Laratta J, Slobogean G, Mehta S. Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis. J Orthop Trauma. 2017;31(2):64–70.CrossRef
40.
Coleman JR, Leasia K, Douglas IS, Hosokawa P, Lawless RA, Moore EE, Pieracci F. Quantifying the expense of deferring surgical stabilization of rib fractures: Operative management of rib fractures is associated with significantly lower charges. J Trauma Acute Care Surg. 2020;89(6):1032–8.CrossRef
41.
Choi J, Khan S, Hakes NA, Carlos G, Seltzer R, Jaramillo JD, Spain DA. Prospective Study of Short-Term Quality-of-Life After Traumatic Rib Fractures. J Trauma Acute Care Surg. 2020.
42.
Marasco SF, Martin K, Niggemeyer L, Summerhayes R, Fitzgerald M, Bailey M. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury. 2019;50(1):119–24.CrossRef
43.
Kane ED, Jeremitsky E, Pieracci FM, Majercik S, Doben AR. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83(6):1047–52.CrossRef
44.
Ingoe HM, Eardley W, McDaid C, Rangan A, Lawrence T, Hewitt C. Epidemiology of adult rib fracture and factors associated with surgical fixation: Analysis of a chest wall injury dataset from England and Wales. Injury. 2020;51(2):218–23.CrossRef
45.
Wijffels MME, Prins JTH, Polinder S, Blokhuis TJ, De Loos ER, Den Boer RH, Flikweert ER, Pull Ter Gunne AF, Ringburg AN, Spanjersberg WR, et al. Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial. World J Emerg Surg. 2019;14:38.
46.
Beks RB, Reetz D, de Jong MB, Groenwold RHH, Hietbrink F, Edwards MJR, Leenen LPH, Houwert RM, Frolke JPM. Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study. Eur J Trauma Emerg Surg. 2019;45(4):655–63.CrossRef
47.
Chapman BC, Overbey DM, Tesfalidet F, Schramm K, Stovall RT, French A, Johnson JL, Burlew CC, Barnett C, Moore EE, et al. Clinical utility of chest computed tomography in patients with rib fractures ct chest and rib fractures. Arch Trauma Res. 2016;5(4):e37070.CrossRef
48.
Murphy CEt, Raja AS, Baumann BM, Medak AJ, Langdorf MI, Nishijima DK, Hendey GW, Mower WR, Rodriguez RM. Rib Fracture Diagnosis in the Panscan Era. Ann Emerg Med. 2017;70(6):904–9.
49.
Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of Rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905–11.PubMed
50.
Singleton JM, Bilello LA, Canham LS, Levenson RB, Lopez GJ, Tadiri SP, Shapiro NI, Rosen CL. Chest computed tomography imaging utility for radiographically occult rib fractures in elderly fall-injured patients. J Trauma Acute Care Surg. 2019;86(5):838–43.CrossRef
Metadata
Title
Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands
Authors
Jonne T. H. Prins
Mathieu M. E. Wijffels
Sophie M. Wooldrik
Martien J. M. Panneman
Michael H. J. Verhofstad
Esther M. M. Van Lieshout
Publication date
12-04-2021
Publisher
Springer Berlin Heidelberg
Keywords
Rib Fracture
Care
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01662-8

Other articles of this Issue 5/2022

European Journal of Trauma and Emergency Surgery 5/2022 Go to the issue

Original Article

Intra-operative ultrasound: does it improve the results of percutaneous repair of acute Achilles tendon rupture?

Original Article

Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital

Review Article

Impact of resuscitative endovascular balloon occlusion of the aorta (REBOA) in traumatic abdominal and pelvic exsanguination: a systematic review and meta-analysis

Original Article

Pipkin fractures: epidemiology and outcome

Original Article

Physiology dictated treatment after severe trauma: timing is everything

Correction

Correction to: Treatment and outcomes of anticoagulated geriatric trauma patients with traumatic intracranial hemorrhage after falls