• Eur J Trauma Emerg Surg · Dec 2023

    Meta Analysis

    Surgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials.

    • Rafael Oliva Morgado Ferreira, Eric Pasqualotto, Patrícia Viana, Pedro Henrique Siedschlag Schmidt, Leonardo Andrighetti, Matheus Pedrotti Chavez, Felippe Flausino, and Getúlio Rodrigues de Oliveira Filho.
    • Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil. rafaelmorgadof9@gmail.com.
    • Eur J Trauma Emerg Surg. 2023 Dec 1; 49 (6): 253125412531-2541.

    PurposeConflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment.MethodsEmbase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I2 statistics.ResultsSix RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I2 = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I2 = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I2 = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I2 = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I2 = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I2 = 54%; GRADE: moderate; PI 0.11, 3.24) was found.ConclusionsOur results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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