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Multicenter Study
. 2024 May 1;96(5):769-776.
doi: 10.1097/TA.0000000000004183. Epub 2023 Nov 7.

Nonoperative treatment of multiple rib fractures, the results to beat: International multicenter prospective cohort study among 845 patients

Felix Peuker  1 , Ruben J Hoepelman, Frank J P Beeres, Zsolt J Balogh, Reinier B Beks, Arthur A R Sweet, Frank F A IJpma, Koen W W Lansink, Bas van Wageningen, Tjarda N Tromp, Fabrizio Minervini, Nicole M van Veelen, Jochem M Hoogendoorn, Mirjam B de Jong, Mark C P M van Baal, Luke P H Leenen, Rolf H H Groenwold, R Marijn Houwert
Affiliations
Multicenter Study

Nonoperative treatment of multiple rib fractures, the results to beat: International multicenter prospective cohort study among 845 patients

Felix Peuker et al. J Trauma Acute Care Surg. .

Abstract

Background: Optimal treatment (i.e., nonoperative or operative) for patients with multiple rib fractures remains debated. Studies that compare treatments are rationalized by the alleged poor outcomes of nonoperative treatment.

Methods: The aim of this prospective international multicenter cohort study (between January 2018 and March 2021) with 1-year follow-up, was to report contemporary outcomes of nonoperatively treated patients with multiple rib fractures. Including 845 patients with three or more rib fractures. Primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (HLOS), (pulmonary) complications, and quality of life.

Results: Mean age was 57.7 ± 17.0 years, median Injury Severity Score was 17 (13-22) and the median number of rib fractures was 6 (4-8). In-hospital mortality rate was 1.5% (n = 13), 112 (13.3%) patients had pneumonia and four (0.5%) patients developed a symptomatic nonunion. The median HLOS was 7 days (4-13 days), and median intensive care unit length of stay was 2 days (1-5 days). Mean 5-Level Quality of Life Questionnaire index value was 0.83 ± 0.18 1 year after trauma. Polytrauma patients had a median HLOS of 10 days (6-18 days), a pneumonia rate of 17.6% (n = 77) and mortality rate of 1.7% (n = 7). Elderly patients (≥65 years) had a median HLOS of 9 days (5-15 days), a pneumonia rate of 19.7% (n = 57) and mortality rate of 4.1% (n = 12).

Conclusion: Overall, nonoperative treatment of patients with multiple rib fractures shows low mortality and morbidity rate and good quality of life after 1 year. Future studies evaluating the benefit of operative stabilization should use contemporary outcomes to establish the therapeutic margin of rib fixation.

Level of evidence: Therapeutic/Care Management; Level III.

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References

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