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Quality of life outcomes after surgical intervention in patients with multiple rib fractures: A prospective cohort study

Published:January 17, 2023DOI:https://doi.org/10.1016/j.surg.2022.12.006

      Abstract

      Background

      Optimized conservative treatment of rib fractures has long been practiced, but surgical fixation has not been promising until recently. We aimed to examine and analyze immediate postoperative outcomes and 6-month quality of life after injury in patients with moderately severe traumatic rib fractures.

      Methods

      We conducted a prospective cohort study between July 2017 and June 2019 at the National Taiwan University Hospital. Seventy-two patients with moderately severe thoracic trauma were enrolled; 38 received conservative treatment and 34 underwent surgical fixation. Quality of life was measured using the 36-item Short Form Survey at; the first 3 days of hospitalization; before discharge; and at 1-, 2-, and 6-month follow-ups (visits 1–5). Baseline characteristics and clinical outcomes were recorded, and linear regression analysis was conducted using the generalized estimating equation.

      Results

      Among patients with moderately severe thoracic injury (chest Abbreviated Injury Scale score≥ 2), the operative group had more severe injuries and longer intensive care unit and in-hospital stays. However, they had a comparable quality of life 6 months after injury and higher physical component scores in the early postoperative period. Linear regression analysis obtained an equation with several factors positively affecting prediction of the mean physical component score, such as body mass index ≤25, age ≤36 years, fewer ribs requiring fixation, and diabetes mellitus. Mental component score did not show an upward trend, but the Work Quality Index largely determined the predicted mean value of the mental component score.

      Conclusion

      Surgical rib fixations hasten recovery in patients with severe thoracic injury (chest Abbreviated Injury Scale ≥3) to achieve 6-month quality of life comparable to patients injured less severely (chest Abbreviated Injury Scale ≥2). The ability to resume previous work positively influenced the mental component score; thus, surgical intervention should also aim to help patients regain their social function.
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      References

        • de Moya M.
        • Nirula R.
        • Biffl W.
        Rib fixation: who, what, when?.
        Trauma Surg Acute Care Open. 2017; 2e000059
        • Liu X.
        • Xiong K.
        Surgical management versus non-surgical management of rib fractures in chest trauma:a systematic review and meta-analysis.
        J Cardiothorac Surg. 2019; 14: 45
        • de Campos J.R.M.
        • White T.W.
        Chest wall stabilization in trauma patients: why, when, and how?.
        J Thorac Dis. 2018; 10: S951-S962
        • Bhatnagar A.
        • Mayberry J.
        • Nirula R.
        Rib fracture fixation for flail chest: what is the benefit?.
        J Am Coll Surg. 2012; 215: 201-205
        • Marasco S.F.
        • Davies A.R.
        • Cooper J.
        • et al.
        Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.
        J Am Coll Surg. 2013; 216: 924-932
        • Ingoe H.M.
        • Coleman E.
        • Eardley W.
        • Rangan A.
        • Hewitt C.
        • McDaid C.
        Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults.
        BMJ Open. 2019; 9e023444
        • Owattanapanich N.
        • Lewis M.R.
        • Benjamin E.R.
        • Jakob D.A.
        • Demetriades D.
        Surgical rib fixation in isolated flail chest improves survival.
        Ann Thorac Surg. 2022; 113: 1859-1865
        • Pieracci F.M.
        • Lin Y.
        • Rodil M.
        • et al.
        A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures.
        J Trauma Acute Care Surg. 2016; 80: 187-194
        • Gerakopoulos E.
        • Walker L.
        • Melling D.
        • Scott S.
        • Scott S.
        Surgical management of multiple rib fractures reduces the hospital length of stay and the mortality rate in major trauma patients: a comparative study in a UK Major Trauma Center.
        J Orthop Trauma. 2019; 33: 9-14
        • Beks R.B.
        • de Jong M.B.
        • Houwert R.M.
        • et al.
        Long-term follow-up after rib fixation for flail chest and multiple rib fractures.
        Eur J Trauma Emerg Surg. 2019; 45: 645-654
        • Peek J.
        • Kremo V.
        • Beks R.
        • et al.
        Long-term quality of life and functional outcome after rib fracture fixation.
        Eur J Trauma Emerg Surg. 2022; 48: 255-264
        • Taft C.
        • Karlsson J.
        • Sullivan M.
        Do SF-36 summary component scores accurately summarize subscale scores?.
        Qual Life Res. 2001; 10: 395-404
        • Laucis N.C.
        • Hays R.D.
        • Bhattacharyya T.
        Scoring the SF-36 in orthopaedics: a brief guide.
        J Bone Joint Surg Am. 2015; 97: 1628-1634
        • Chu S.Y.
        • Tsai Y.H.
        • Xiao S.H.
        • Huang S.J.
        • Yang C.C.
        Quality of return to work in patients with mild traumatic brain injury: a prospective investigation of associations among post-concussion symptoms, neuropsychological functions, working status and stability.
        Brain Inj. 2017; 31: 1674-1682
        • Yan J.
        Yet another package for generalized estimating equations.
        R News. 2002; 2: 12-14
        • Yan J.
        • Fine J.
        Estimating equations for association structures.
        Stat Med. 2004; 23 (discussion 875–7,879–80): 859-874
        • Halekoh U.
        • Højsgaard S.
        • Yan J.
        The R package geepack for generalized estimating equations.
        J Stat Softw. 2006; 15: 1-11
        • McCarthy M.L.
        • MacKenzie E.J.
        • Durbin D.R.
        • et al.
        Health-related quality of life during the first year after traumatic brain injury.
        Arch Pediatr Adolesc Med. 2006; 160: 252-260
        • Marasco S.F.
        • 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: 119-124
        • Walters S.T.
        • Craxford S.
        • Russell R.
        • et al.
        Surgical stabilization improves 30-day mortality in patients with traumatic flail chest: a comparative case series at a major trauma center.
        J Orthop Trauma. 2019; 33: 15-22
        • Farquhar J.
        • Almarhabi Y.
        • Slobogean G.
        • et al.
        No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.
        Can J Surg. 2016; 59: 299-303
        • Caragounis E.C.
        • Fagevik Olsén M.
        • Pazooki D.
        • Granhed H.
        Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study.
        World J Emerg Surg. 2016; 11: 27
        • Tseng H.M.
        • Lu J.F.
        • Tsai Y.J.
        Assessment of health-related quality of life in Taiwan (Ⅱ): norming and validation of SF-36 Taiwan version.
        Taiwan J Public Health. 2003; 22: 512-518
        • Zeger S.L.
        • Liang K.Y.
        Longitudinal data analysis for discrete and continuous outcomes.
        Biometrics. 1986; 42: 121-130
        • Marasco S.
        • Lee G.
        • Summerhayes R.
        • Fitzgerald M.
        • Bailey M.
        Quality of life after major trauma with multiple rib fractures.
        Injury. 2015; 46: 61-65
        • Archer K.R.
        • Castillo R.C.
        • Mackenzie E.J.
        • Bosse M.J.
        • LEAP Study Group
        Physical disability after severe lower-extremity injury.
        Arch Phys Med Rehabil. 2006; 87: 1153-1155
        • Kohler R.E.
        • Tomlinson J.
        • Chilunjika T.E.
        • Young S.
        • Hosseinipour M.
        • Lee C.N.
        ‘Life is at a standstill’ quality of life after lower extremity trauma in Malawi.
        Qual Life Res. 2017; 26: 1027-1035
        • Kerr-Valentic M.A.
        • Arthur M.
        • Mullins R.J.
        • Pearson T.E.
        • Mayberry J.C.
        Rib fracture pain and disability: can we do better?.
        J Trauma. 2003; 54 (discussion 1063–4): 1058-1063
        • Uchida K.
        • Miyashita M.
        • Kaga S.
        • Noda T.
        • Nishimura T.
        • Yamamoto H.
        • Mizobata Y.
        Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures.
        Trauma Surg Acute Care Open. 2020; 5e000546