The impact of injury severity and age on short-and long-term mortality and hospital length of stay after surgical stabilisation of rib fractures (SSRF): a German population-based propensity-score matched investigation.

Huelskamp MD; Mboulla Nzomo M; Horst N; Acar L; Duesing H; Marschall U; Raschke MJ; Rosslenbroich S

Abstract

BACKGROUND - METHODS - RESULTS - CONCLUSIONS; Surgical stabilisation of rib fractures (SSRF) is a procedure that has been shown to reduce mortality and complications in patients with thoracic trauma. However, correct patient selection is required, since the immunological hit of a thoracic surgery in the context of trauma is not without risk. In this study we aimed to analyse real-world data on the effect of SSRF mortality and hospital length of stay.; A retrospective propensity matched analysis of real-world health claims data of a German statutory health insurance company of Management of serial rib fractures and unstable thorax via SSRF compared to conservative treatment was performed. The primary endpoints were in-hospital mortality, 1 year post hospital mortality and intensive-care unit length of stay. Subgroup analyses with respect to age-group, overall injury severity and time-point of surgery were performed. Multivariate regression was used to confirm these results and analyse interaction between different variables.; Overall, 62,011 patients with serial rib fractures were identified, of which 532 patients receiving SSRF and 532 receiving conservative management could be matched. The data showed a significant reduction in in-hospital mortality in the SSRF cohort (4.7% for SSRF versus 9.21% for conservative treatment, p = 0.005). Subgroup analysis showed this effect to be most pronounced in patients with high, but not extremely high injury severity (injury severity score (ISS) 16-24). The survival benefit could be demonstrated across age groups, although the extent of the benefit decreased with increasing age. Hospital length of stay was increased in the SSRF cohort, although this effect was driven through an increase in the low injury severity (ISS < 16 subgroup).; Overall, the data shows that SSRF can lead to reduced mortality in appropriately selected patients. Based on this real-world data, patients across all age-groups with high but not extreme injury severity (ISS 16-24), in other words patients in whom the thoracic injury is a major component of overall injury severity, appear to benefit most.