Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis.

Abstract:

OBJECTIVE:To perform a systematic review and meta-analysis of studies comparing operative to nonoperative therapy in adult FC patients. Outcomes were duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS), hospital length of stay (HLOS), mortality, incidence of pneumonia, and tracheostomy. BACKGROUND:Flail chest (FC) results in paradoxical chest wall movement, altered respiratory mechanics, and frequent respiratory failure. Despite advances in ventilatory management, FC remains associated with significant morbidity and mortality. Operative fixation of the flail segment has been advocated as an adjunct to supportive care, but no definitive clinical trial exists to delineate the role of surgery. METHODS:A comprehensive search of 5 electronic databases was performed to identify randomized controlled trials and observational studies (cohort or case-control). Pooled effect size (ES) or relative risk (RR) was calculated using a fixed or random effects model, as appropriate. RESULTS:Nine studies with a total of 538 patients met inclusion criteria. Compared with control treatment, operative management of FC was associated with shorter DMV [pooled ES: -4.52 days; 95% confidence interval (CI): -5.54 to -3.50], ICULOS (-3.40 days; 95% CI: -6.01 to -0.79), HLOS (-3.82 days; 95% CI: -7.12 to -0.54), and decreased mortality (pooled RR: 0.44; 95% CI: 0.28-0.69), pneumonia (0.45; 95% CI: 0.30-0.69), and tracheostomy (0.25; 95% CI: 0.13-0.47). CONCLUSIONS:As compared with nonoperative therapy, operative fixation of FC is associated with reductions in DMV, LOS, mortality, and complications associated with prolonged MV. These findings support the need for an adequately powered clinical study to further define the role of this intervention.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Leinicke JA,Elmore L,Freeman BD,Colditz GA

doi

10.1097/SLA.0b013e3182895bb0

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

914-21

issue

6

eissn

0003-4932

issn

1528-1140

journal_volume

258

pub_type

杂志文章,meta分析,评审
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    doi:10.1097/SLA.0b013e3182a4e87c

    authors: Zureikat AH,Moser AJ,Boone BA,Bartlett DL,Zenati M,Zeh HJ 3rd

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  • Infected aortic aneurysms. A changing entity.

    abstract::Infected (mycotic) aortic aneurysms are infrequent and, without surgical intervention, usually lead to uncontrolled sepsis or catastrophic hemorrhage. Symptoms are frequently absent or non-specific during the early stages, and a high index of suspicion is essential to make the diagnosis. Surgery performed after ruptur...

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    doi:10.1097/00000658-199205000-00005

    authors: Gomes MN,Choyke PL,Wallace RB

    更新日期:1992-05-01 00:00:00

  • Primary Open Versus Closed Implantation Strategy for Totally Implantable Venous Access Ports: The Multicentre Randomized Controlled PORTAS-3 Trial (DRKS 00004900).

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    doi:10.1097/SLA.0000000000003705

    authors: Hüttner FJ,Bruckner T,Hackbusch M,Weitz J,Bork U,Kotschenreuther P,Heupel O,Kümmel S,Schlitt HJ,Mattulat M,Pintér L,Seiler CM,Gutt CN,Nottberg HS,Pohl A,Ghanem F,Meyer T,Imdahl A,Neudecker J,Müller VA,Gehrig T,R

    更新日期:2020-12-01 00:00:00

  • Management of Five Hundred Patients With Gut Failure at a Single Center: Surgical Innovation Versus Transplantation With a Novel Predictive Model.

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    doi:10.1097/SLA.0000000000003523

    authors: Abu-Elmagd KM,Armanyous SR,Fujiki M,Parekh NR,Osman M,Scalish M,Newhouse E,Fouda Y,Lennon E,Shatnawei A,Kirby D,Steiger E,Khanna A,Radhakrishnan K,Quintini C,Hashimoto K,Barnes J,Costa G

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    pub_type: 杂志文章

    doi:10.1097/01.sla.0000129358.80798.62

    authors: Silberman AW,McVay C,Cohen JS,Altura JF,Brackert S,Sarna GP,Palmer D,Ko A,Memsic L

    更新日期:2004-07-01 00:00:00

  • Influence of modest endotoxemia on postoperative antithrombin deficiency and circulating secretory immunoglobulin a levels.

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    authors: Fujita T,Imai T,Anazawa S

    更新日期:2003-08-01 00:00:00

  • When Do DCD Donors Die?: Outcomes and Implications of DCD at a High-volume, Single-center OPO in the United States.

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    pub_type: 杂志文章

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  • A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment.

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    pub_type: 杂志文章

    doi:10.1097/00000658-198902000-00004

    authors: Neoptolemos JP,Shaw DE,Carr-Locke DL

    更新日期:1989-02-01 00:00:00

  • Benefit-risk balance of reoperation for persistent medullary thyroid cancer.

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    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e31826bc239

    authors: Machens A,Dralle H

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    pub_type: 临床试验,杂志文章

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    更新日期:1983-07-01 00:00:00

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    pub_type: 杂志文章,评审

    doi:10.1097/00000658-198911000-00017

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    pub_type: 杂志文章

    doi:10.1097/00000658-198104000-00012

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    更新日期:1981-04-01 00:00:00

  • Unsuccessful experience with closure of Jaboulay gastroduodenostomies in the treatment of post-vagotomy dumping and diarrhea.

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    pub_type: 杂志文章

    doi:10.1097/00000658-198308000-00005

    authors: Hoffmann J,Fischer A,Jensen HE

    更新日期:1983-08-01 00:00:00

  • Hypothermic circulatory arrest for cerebral protection during combined carotid and cardiac surgery in patients with bilateral carotid artery disease.

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    journal_title:Annals of surgery

    pub_type: 杂志文章,评审

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    更新日期:1994-06-01 00:00:00

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    pub_type: 杂志文章

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    pub_type: 杂志文章

    doi:10.1097/00000658-200002000-00007

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    更新日期:2000-02-01 00:00:00

  • Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity.

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    pub_type: 杂志文章

    doi:10.1097/00000658-199203000-00012

    authors: Williard WC,Hajdu SI,Casper ES,Brennan MF

    更新日期:1992-03-01 00:00:00

  • Massive Ringer's lactate infusion: comparison with dextrose 5% and whole blood.

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    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197511000-00018

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    更新日期:1975-11-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:2008-01-01 00:00:00

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    pub_type: 临床试验,杂志文章

    doi:10.1097/00000658-199503000-00009

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    更新日期:1995-03-01 00:00:00

  • Platelet-rich fibrin versus albumin in surgical wound repair: a randomized trial with paired design.

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    pub_type: 杂志文章,随机对照试验

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    更新日期:2010-05-01 00:00:00

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    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

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    doi:10.1097/00000658-197506000-00007

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    pub_type: 杂志文章

    doi:10.1097/00000658-198012000-00011

    authors: Schuffler MD,Deitch EA

    更新日期:1980-12-01 00:00:00

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    doi:10.1097/00000658-198102000-00021

    authors: Unger SW,Wanebo HJ,Cooper PH

    更新日期:1981-02-01 00:00:00