Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study
Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study
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DOI：
10.1016/j.athoracsur.2020.03.084
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发表时间：
2020-09-01
影响因子：
4.6
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Otaka, Shunichi;Aso, Shotaro;Yasunaga, Hideo
背景肋骨固定的适当时机尚不清楚。我们研究了早期肋骨固定与晚期肋骨固定的疗效比较，数据来自日本全国住院患者数据库。我们使用来自日本诊断程序组合数据库的数据，确定了2010年7月1日至2018年3月31日接受肋骨固定并接受机械通气的患者。主要结局是肋骨固定后机械通气的持续时间。次要结局是肋骨固定后住院时间、总住院费用、气管切开术、入院后肺炎和28天全因住院死亡率。我们进行了倾向评分调整分析，以比较入院后≤ 6天行肋骨固定的患者和入院后6天以上行肋骨固定的患者的结局。我们确定了211例患者，包括113例接受早期肋骨固定的患者和98例接受晚期肋骨固定的患者。在倾向评分调整分析中，早期肋骨固定与较短的机械通气时间相关（差异，-26.7%; 95%置信区间[CI]，-39.4%至-11.4%），住院时间缩短（差异，-33.3%; 95% CI，-52.8%至-5.6%），总住院费用较低（差异，-28.7%; 95% CI，-38.4%至-17.5%）。两组患者接受气管切开术的比例（比值比[OR]，0.67; 95%CI，0.31-1.48）、入院后肺炎（OR，0.74，95%CI，0.33-1.65）或全因28天住院死亡率（OR，0.90，95%CI，0.06-12.5）无显著差异。早期肋骨固定与更好的住院结局相关。(C)2020年美国胸外科医师协会
Background. The appropriate timing of rib fixation remains unclear. We investigated the efficacy of early rib fixation compared with late rib fixation, using data from a Japanese nationwide inpatient database.Methods. We identified patients who underwent rib fixation and received mechanical ventilation from July 1, 2010, to March 31, 2018, using data from the Diagnosis Procedure Combination database in Japan. The primary outcome was the duration of mechanical ventilation after rib fixation. Secondary outcomes were the length of hospital stay after rib fixation, total hospitalization costs, tracheostomy, pneumonia after admission, and all-cause 28-day in-hospital mortality. We performed propensity score-adjusted analyses to compare outcomes between patients undergoing rib fixation less than or equal to 6 days after admission and those undergoing rib fixation greater than 6 days after admission.Results. We identified 211 patients, including 113 patients undergoing early rib fixation and 98 patients undergoing late rib fixation. In the propensity score-adjusted analyses, early rib fixation was associated with shorter duration of mechanical ventilation (difference, -26.7%; 95% confidence interval [CI], -39.4% to -11.4%), shorter length of hospital stay (difference, -33.3%; 95% CI, -52.8% to -5.6%), and lower total hospitalization costs (difference, -28.7%; 95% CI, -38.4% to -17.5%). There were no significant differences between the groups regarding the proportions of patients receiving tracheostomy (odds ratio [OR], 0.67; 95% CI, 0.31-1.48), pneumonia after admission (OR, 0.74, 95% CI, 0.33-1.65), or all-cause 28-day in-hospital mortality (OR, 0.90, 95% CI, 0.06-12.5).Conclusions. Early rib fixation was associated with better in-hospital outcomes. (C) 2020 by The Society of Thoracic Surgeons