Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture
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ORIGINAL ARTICLE
Comparison of surgical fixation and non‑operative management in patients with traumatic sternum fracture Ashton B. Christian1 · Areg Grigorian2 · Jeffry Nahmias1 · William Q. Duong1 · Michael Lekawa1 · Victor Joe1 · Matthew Dolich1 · Sebastian D. Schubl1 Received: 27 May 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The incidence of sternal fractures in blunt trauma patients lies between 3 and 7%. The role, timing and indications for surgical management are not well delineated and remain controversial for patients undergoing surgical stabilization of sternum fracture (SSSF). We sought to identify the national rate of SSSF in patients with a sternum fracture hypothesizing patients undergoing SSSF will have a decreased rate of mortality and complications. Methods The Trauma Quality Improvement Program (2015–2016) was queried for patients with sternum fracture. Propensity scores were calculated to match patients undergoing SSSF to patients managed non-operatively in a 1:2 ratio using demographic data. Results From 9460 patients with a sternum fracture, 114 (1.2%) underwent SSSF. After propensity-matching, 112 SSSF patients were compared to 224 patients undergoing non-operative management (NOM). There were no differences in matched characteristics (all p > 0.05). Compared to patients undergoing NOM, patients undergoing SSSF had an increased median length of stay (LOS) (16 vs. 7 days, p 3) for the Abbreviated Injury Scale (AIS) of the head, thorax and abdomen. The specific comorbidities used for propensity matching included hypertension, chronic obstructive pulmonary disease, chronic renal failure, smoking status, and diabetes. The specific injuries used for propensity matching include pelvic fracture, rib fractures, upper/lower extremity fracture, spine fracture, thoracic vessel injury, heart injury, traumatic brain injury, splenic injury, liver injury, and lung injuries including hemothorax, pneumothorax, and unspecified lung injuries. The primary outcome was mortality. Secondary outcomes included total hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, and in-hospital complications. In-hospital complications included acute kidney injury, acute respiratory distress syndrome, cardiac arrest, deep site infection, deep vein thrombosis, myocardial infarction, organ space infection, pneumonia, pulmonary embolism, cerebrovascular accident, superficial infection, unplanned intubation, urinary tract infection, unplanned return to the operating room, unplanned ICU admission, severe sepsis, catheter-associated urinary tract infection, ventilator-acquired pneumonia, and other unclassified complications. All variables were coded as either present or absent. Descriptive statistics were performed for all variables. A Student’s t test or Mann–Whitney U test was used to compare continuous variables and a chi-square was used to compare categorical variables for bivariate analysis. Categorical data were presented as perc
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