Introduction: Evidence for treating severe rib fractures without a flail component (non-flail) has not yet been adequately evaluated. This study analyzed contemporary evidence for the surgical versus non-surgical treatment of adults with severe chest rib fractures, with further analysis by the flail component.
Materials and Methods: A systematic literature review and meta-analysis included studies evaluating patients with surgical fixation of severe rib fractures. All studies included non-flail patients. Random effects models pooled data for outcomes reported in ≥ 2 studies. The primary outcome was the duration of mechanical ventilation (DMV). Secondary outcomes included post-procedural pain, respiratory complications, mortality, tracheostomy, sepsis, intensive care unit (ICU), and hospital length of stay (LOS).
Results: Thirty-one studies (n=99,640 patients) evaluating surgical fixation of severe rib fracture patients were included in the meta-analysis. Surgical fixation resulted in statistically significantly shorter DMV (-1.81 days, 95% confidence interval (CI): -3.14 to -0.49 days; p=0.007), lower 2-week pain intensity (SMD -3.29, 95% CI: -5.05 to -1.53; p=0.003), lower risk for atelectasis (RR=0.41, 95% CI: 0.25-0.67; p=0.0003), lower risk for any respiratory complication (RR=0.63, 95% CI: 0.43- 0.92, p=0.02), and lower mortality risk (RR=0.41, 95% CI: 0.23-0.73, p=0.003) compared to non-surgical treatment. Statistically significant differences were not observed for pain 3-day after intervention (SMD -1.28, 95% CI: -3.32 to 0.75; p=0.22); pneumonia (RR=0.66, 95% CI: 0.40- 1.08; p=0.10), acute respiratory distress syndrome (RR 1.19, 95% CI: 0.18-7.96; p=0.85), tracheotomy (RR 0.66, 95% CI: 0.30-1.44, p=0.29), sepsis (RR=0.75, 95% CI: 0.17-3.28, p=0.70), ICU LOS (MD -1.01, 95% CI: -2.42 to 0.939; p=0.16), and hospital LOS (MD-1.52, 95% CI: -3.97 to 0.92; p=0.22).
Conclusion: Surgical treatment of patients with severe rib fractures, including a majority of non-flail patients, resulted in statistically significantly shorter DMV, less 2-week pain, lower risk of atelectasis and overall respiratory complications, and reduced mortality compared to non-surgical treatment.
Rib fractures, Rib fixation, Surgery, Duration of mechanical ventilation