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European Journal of Trauma and Emergency Surgery

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Open Access 25-08-2022 | Rib Fracture | Original Article

Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study

Authors: Ruben J. Hoepelman, Frank. J. P. Beeres, Reinier B. Beks, Arthur A. R. Sweet, Frank F. Ijpma, Koen W. W. Lansink, Bas van Wageningen, Tjarda N. Tromp, Björn-Christian Link, Nicole M. van Veelen, Jochem. M. Hoogendoorn, Mirjam B. de Jong, Mark. C. P. van Baal, Luke P. H. Leenen, Rolf H. H. Groenwold, Roderick M. Houwert

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2023

Abstract

Background

Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking.

Methods

We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching.

Results

In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8–9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI − 0.2–0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation.

Conclusions

We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures.

Trial registration

Registered in the Netherlands Trial Register NTR6833 on 13/11/2017.

Available only for authorised users

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Title: Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study
Authors: Ruben J. Hoepelman
Frank. J. P. Beeres
Reinier B. Beks
Arthur A. R. Sweet
Frank F. Ijpma
Koen W. W. Lansink
Bas van Wageningen
Tjarda N. Tromp
Björn-Christian Link
Nicole M. van Veelen
Jochem. M. Hoogendoorn
Mirjam B. de Jong
Mark. C. P. van Baal
Luke P. H. Leenen
Rolf H. H. Groenwold
Roderick M. Houwert
Publication date: 25-08-2022
Publisher: Springer Berlin Heidelberg
Keyword: Rib Fracture
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02093-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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