Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema

• Published in: The American journal of surgery Vol. 210; no. 6; pp. 1112 - 1117
• Main Authors: Majercik, Sarah, Vijayakumar, Sathya, Olsen, Griffin, Wilson, Emily, Gardner, Scott, Granger, Steven R., Van Boerum, Don H., White, Thomas W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015; Elsevier Limited
• Subjects: Data collection; Empyema - diagnostic imaging; Empyema - etiology; Empyema - microbiology; Female; Hemothorax - diagnostic imaging; Hemothorax - etiology; Hemothorax - surgery; Hospitals; Humans; Injury Severity Score; Intensive care; Male; Medical records; Middle Aged; Narcotics; Ostomy; Outcomes; Pain; Propensity Score; Radiography, Thoracic; Registries; Retained hemothorax; Rib fractures; Rib Fractures - complications; Rib Fractures - diagnostic imaging; Rib Fractures - surgery; Surgery; Surgical stabilization of rib fractures; Thoracic trauma; Tomography, X-Ray Computed; Trauma; Retained hemothorax; Rib fractures; Thoracic trauma; Surgical stabilization of rib fractures; Outcomes
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.08.008

Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank–sum tests. One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002). Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked.