Operative management of Rib fractures in the setting of flail chest

A systematic review and meta-analysis

Jennifer A Leinicke, Leisha Elmore, Bradley D. Freeman, Graham A. Colditz

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

OBJECTIVE:: To perform a systematic review and meta-analysis of studies comparing operative to nonoperative therapy in adult FC patients. Outcomes were duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS), hospital length of stay (HLOS), mortality, incidence of pneumonia, and tracheostomy. BACKGROUND:: Flail chest (FC) results in paradoxical chest wall movement, altered respiratory mechanics, and frequent respiratory failure. Despite advances in ventilatory management, FC remains associated with significant morbidity and mortality. Operative fixation of the flail segment has been advocated as an adjunct to supportive care, but no definitive clinical trial exists to delineate the role of surgery. METHODS:: A comprehensive search of 5 electronic databases was performed to identify randomized controlled trials and observational studies (cohort or case-control). Pooled effect size (ES) or relative risk (RR) was calculated using a fixed or random effects model, as appropriate. RESULTS:: Nine studies with a total of 538 patients met inclusion criteria. Compared with control treatment, operative management of FC was associated with shorter DMV [pooled ES:-4.52 days; 95% confidence interval (CI):-5.54 to-3.50], ICULOS (-3.40 days; 95% CI:-6.01 to-0.79), HLOS (-3.82 days; 95% CI:-7.12 to-0.54), and decreased mortality (pooled RR: 0.44; 95% CI: 0.28-0.69), pneumonia (0.45; 95% CI: 0.30-0.69), and tracheostomy (0.25; 95% CI: 0.13-0.47). CONCLUSIONS:: As compared with nonoperative therapy, operative fixation of FC is associated with reductions in DMV, LOS, mortality, and complications associated with prolonged MV. These findings support the need for an adequately powered clinical study to further define the role of this intervention.

Original languageEnglish (US)
Pages (from-to)914-921
Number of pages8
JournalAnnals of surgery
Volume258
Issue number6
DOIs
StatePublished - Dec 1 2013

Fingerprint

Flail Chest
Rib Fractures
Meta-Analysis
Length of Stay
Confidence Intervals
Artificial Respiration
Mortality
Tracheostomy
Intensive Care Units
Pneumonia
Respiratory Mechanics
Thoracic Wall
Respiratory Insufficiency
Observational Studies
Therapeutics
Randomized Controlled Trials
Clinical Trials
Databases
Morbidity
Incidence

Keywords

  • flail chest
  • meta-analysis
  • rib fracture
  • surgical procedures

ASJC Scopus subject areas

  • Surgery

Cite this

Operative management of Rib fractures in the setting of flail chest : A systematic review and meta-analysis. / Leinicke, Jennifer A; Elmore, Leisha; Freeman, Bradley D.; Colditz, Graham A.

In: Annals of surgery, Vol. 258, No. 6, 01.12.2013, p. 914-921.

Research output: Contribution to journalArticle

Leinicke, Jennifer A ; Elmore, Leisha ; Freeman, Bradley D. ; Colditz, Graham A. / Operative management of Rib fractures in the setting of flail chest : A systematic review and meta-analysis. In: Annals of surgery. 2013 ; Vol. 258, No. 6. pp. 914-921.
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