Effectiveness of surgical fixation for rib fractures in relation to its timing: a retrospective Japanese nationwide study

Otaka, Shunichi; Aso, Shotaro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

PURPOSE: The effectiveness of surgical rib fixation is currently controversial, partly because of differences in timing. We used a Japanese nationwide database to investigate the effectiveness of surgical rib fixation in relation to its timing. METHODS: We used the Japanese Diagnosis Procedure Combination database to identify patients with rib fractures who underwent mechanical ventilation from 1 July 2010 to 31 March 2018. We performed overlap weight analysis to compare in-hospital outcomes between patients who had and had not undergone surgical rib fixation within 3, 6 or 10 days after admission. The primary outcomes were duration of mechanical ventilation and post-rib fixation length of hospital stay. The secondary outcomes were tracheostomy, post-admission pneumonia and all-cause 28-day in-hospital mortality. RESULTS: We identified 8922 eligible patients. Surgical rib fixation within 3 days after admission was associated with shorter duration of mechanical ventilation (percent difference, − 42.9%; 95% confidence interval, − 57.4 to − 23.3) and shorter hospital stay (percent difference, − 19.6%; 95% confidence interval, − 31.8 to − 5.2). There were no significant differences between the groups in tracheostomy (risk difference, − 0.04; 95% confidence interval, − 0.15 to 0.07), post-admission pneumonia (risk difference, − 0.04; 95% confidence interval, − 0.13 to 0.05) or all-cause 28-day in-hospital mortality (risk difference, − 0.02; 95% confidence interval, − 0.07 to 0.03). However, there were no significant differences in any in-hospital outcomes between those who had and had not undergone rib fixation within 6 or 10 days after admission. CONCLUSION: Early surgical rib fixation was associated with better in-hospital outcomes, whereas later surgical rib fixation was not. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00068-020-01548-1) contains supplementary material, which is available to authorized users.