TY - JOUR
T1 - Operative management of Rib fractures in the setting of flail chest
T2 - A systematic review and meta-analysis
AU - Leinicke, Jennifer A.
AU - Elmore, Leisha
AU - Freeman, Bradley D.
AU - Colditz, Graham A.
PY - 2013/12
Y1 - 2013/12
N2 - 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.
AB - 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.
KW - flail chest
KW - meta-analysis
KW - rib fracture
KW - surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=84888138547&partnerID=8YFLogxK
U2 - 10.1097/SLA.0b013e3182895bb0
DO - 10.1097/SLA.0b013e3182895bb0
M3 - Article
C2 - 23511840
AN - SCOPUS:84888138547
SN - 0003-4932
VL - 258
SP - 914
EP - 921
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -