Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide stud
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ORIGINAL ARTICLE
Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study Shunichi Otaka1 · Shotaro Aso2 · Hiroki Matsui1 · Kiyohide Fushimi3 · Hideo Yasunaga1 Received: 3 July 2020 / Accepted: 2 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The effectiveness of surgical rib fixation is currently controversial, partly because of differences in timing. We used a Japanese nationwide database to investigate the effectiveness of surgical rib fixation in relation to its timing. Methods We used the Japanese Diagnosis Procedure Combination database to identify patients with rib fractures who underwent mechanical ventilation from 1 July 2010 to 31 March 2018. We performed overlap weight analysis to compare in-hospital outcomes between patients who had and had not undergone surgical rib fixation within 3, 6 or 10 days after admission. The primary outcomes were duration of mechanical ventilation and post-rib fixation length of hospital stay. The secondary outcomes were tracheostomy, post-admission pneumonia and all-cause 28-day in-hospital mortality. Results We identified 8922 eligible patients. Surgical rib fixation within 3 days after admission was associated with shorter duration of mechanical ventilation (percent difference, − 42.9%; 95% confidence interval, − 57.4 to − 23.3) and shorter hospital stay (percent difference, − 19.6%; 95% confidence interval, − 31.8 to − 5.2). There were no significant differences between the groups in tracheostomy (risk difference, − 0.04; 95% confidence interval, − 0.15 to 0.07), post-admission pneumonia (risk difference, − 0.04; 95% confidence interval, − 0.13 to 0.05) or all-cause 28-day in-hospital mortality (risk difference, − 0.02; 95% confidence interval, − 0.07 to 0.03). However, there were no significant differences in any in-hospital outcomes between those who had and had not undergone rib fixation within 6 or 10 days after admission. Conclusion Early surgical rib fixation was associated with better in-hospital outcomes, whereas later surgical rib fixation was not. Keywords Rib fracture · Rib fixation · Timing · Overlap weights
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00068-020-01548-1) contains supplementary material, which is available to authorized users. * Shunichi Otaka shun‑[email protected] 1
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo 113‑0033, Japan
2
Department of Biostatistics and Bioinformatics, The University of Tokyo, Tokyo, Japan
3
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
Rib fractures are present in 10%–39% of all trauma patients [1, 2]. The symptoms generally do not interfere with daily activities; however, severe pain and chest deformity sometimes restrict thoracic movement and cause respi
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