Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema

Abstract Background Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Methods Admitted rib...

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Bibliographic Details
Published in:The American journal of surgery 2015-12, Vol.210 (6), p.1112-1117
Main Authors: Majercik, Sarah, M.D., M.B.A., F.A.C.S, Vijayakumar, Sathya, M.S., M.B.A, Olsen, Griffin, M.S, Wilson, Emily, M.S, Gardner, Scott, P.A.-C., M.M.Sc, Granger, Steven R., M.D., F.A.C.S, Van Boerum, Don H., M.D., F.A.C.S, White, Thomas W., M.D., F.A.C.S
Format: Article
Language:English
Subjects:
Data collection
Empyema - diagnostic imaging
Empyema - etiology
Empyema - microbiology
Female
Hemothorax - diagnostic imaging
Hemothorax - etiology
Hemothorax - surgery
Hospitals
Humans
Injury Severity Score
Intensive care
Male
Medical records
Middle Aged
Narcotics
Ostomy
Outcomes
Pain
Propensity Score
Radiography, Thoracic
Registries
Retained hemothorax
Rib fractures
Rib Fractures - complications
Rib Fractures - diagnostic imaging
Rib Fractures - surgery
Surgery
Surgical stabilization of rib fractures
Thoracic trauma
Tomography, X-Ray Computed
Trauma
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Summary:Abstract Background Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Methods Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank–sum tests. Results One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF ( P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group ( P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group ( P = .002). Conclusions Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.08.008