• Jonne T H Prins, Van Lieshout Esther M M EMM, Francis Ali-Osman, Zachary M Bauman, Eva-Corina Caragounis, Jeff Choi, D Benjamin Christie, Peter A Cole, William B DeVoe, Andrew R Doben, Evert A Eriksson, Joseph D Forrester, Douglas R Fraser, Brendan Gontarz, Claire Hardman, Daniel G Hyatt, Adam J Kaye, Huan-Jang Ko, Kiara N Leasia, Stuart Leon, Silvana F Marasco, Allison G McNickle, Timothy Nowack, Temi D Ogunleye, Prakash Priya, Aaron P Richman, Victoria Schlanser, Gregory R Semon, Ying-Hao Su, Verhofstad Michael H J MHJ, Julie Whitis, Fredric M Pieracci, and Wijffels Mathieu M E MME.
• From the Trauma Research Unit, Department of Surgery (J.T.H.P., E.M.M.V.L., M.H.J.V., M.M.E.W.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Surgery (F.A.-O.), HonorHealth John C. Lincoln Medical Center, Phoenix, Arizona; Division of Trauma, Emergency General Surgery, Critical Care Surgery, Department of Surgery (Z.M.B.), University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (E.-C.C.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Acute Care Surgery, Department of Surgery (J.C., J.D.F.), Stanford University, Stanford, California; Department of Trauma Surgery/Critical Care (D.B.C., T.N.), Mercer University School of Medicine, The Medical Center Navicent Health, Macon, Georgia; HealthPartners Orthopedics & Sports Medicine (P.A.C.), Bloomington; Department of Orthopaedic Surgery (P.A.C.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (P.A.C.), Regions Hospital, St. Paul, Minnesota; Department of Surgery (W.B.D., D.G.H.), Riverside Methodist Hospital, Columbus, Ohio; Department of Surgery (A.R.D., B.G.), Saint Francis Hospital, Hartfort, Connecticut; Division of Trauma and Critical Care, Department of Surgery (E.A.E., S.L.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (D.R.F., A.G.M.), UNLV School of Medicine, Las Vegas, Nevada; Division of Trauma, Department of Surgery (C.H., G.R.S.), Wright State University/Miami Valley Hospital, Dayton, Ohio; Department of Surgery (A.J.K., P.P.), Overland Park Regional Medical Center, Overland Park, Kansas; Division of Trauma Surgery, Department of Surgery (H.-J.K., Y.-H.S.), National Taiwan University Hospital, Hsinchu City, Taiwan; Department of Surgery (K.N.L.), Denver Health Medical Center, Denver, Colorado; CJOB Department of Cardiothoracic Surgery (S.F.M.), The Alfred, Melbourne; Department of Surgery (S.F.M.), Monash University, Clayton, Victoria, Australia; Department of Orthopaedic Surgery (T.D.O.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (T.D.O.), Regions Hospital, St. Paul, Minnesota; Department of Surgery (A.P.R.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Trauma/Burn (V.S.), John H Stronger Hospital of Cook County, Chicago, Illinois; Department of Surgery (J.W.), University of Texas Rio Grande Valley, Doctors Hospital at Renaissance, Edinburg, Texas; Department of Surgery (F.M.P.), Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado.
• J Trauma Acute Care Surg. 2021 Mar 1; 90 (3): 492-500.

BackgroundOutcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI.MethodsA multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS score, 9-12) and severe (GCS score, ≤8) TBI.ResultsThe study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. The SSRF was performed at a median of 3 days, and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.38-0.98; p = 0.043) and 30-day mortality (OR, 0.32; 95% CI, 0.11-0.91; p = 0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (OR, 0.19; 95% CI, 0.04-0.88; p = 0.034).ConclusionIn patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI.Level Of EvidenceTherapeutic, level IV.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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