Surgical rib fixation: Does increase case volume lead to improved outcomes?

Evaluation of Patient Information Material in the Consent Process for Surgical Stabilization of Rib Fractures

BACKGROUND

Surgical stabilization of rib fractures is a procedure carried out in most trauma centers; however, data on evaluation of patient information material regarding this procedure are limited. The trauma service at our hospital implemented slide presentation as an adjunct tool to the consenting process for patients undergoing this procedure.

OBJECTIVE

The aim was to evaluate information material for patients undergoing surgical stabilization of rib fractures procedure and subjective outcomes from education on components of knowledge, emotion, and behavior for patients undergoing this procedure.

METHODS

A one-group posttest prospective design study was conducted over 18 months at a Level I trauma center. Supplementary visual material was provided as an adjunct to the consent process of surgical rib fixation. Evaluation from the patient's perspective was undertaken utilizing the usefulness scale for patient information material. This tool was based on a tripartite model of reading, evaluating, and responding to patient information material.

RESULTS

Over the period of 18 months, 60 patients underwent surgical stabilization of rib fractures. Fifty-two (91.7%) patients reviewed the information material, and 41 (78.8%) patients completed the feedback. The results reflect that the majority of patients perceived positive responses in emotional support (M = 8.42, SD = 6.6); behavioral motivation (M = 8.57, SD = 6.4); and education on knowledge (M = 9.09, SD = 4.6).

CONCLUSION

In this novel study, visual aids as an adjunct to the informed consent process augmented patient knowledge regarding surgical stabilization of rib fractures and received positive subjective patient feedback on knowledge about the procedure.

Outcomes of rib fractures in the geriatric population: A 5-year retrospective, single-institution, Australian study

BACKGROUND

Surgical rib fixation in the general population can decrease morbidity, including length of stay and ventilator days. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management.

METHODS

A single-centre, retrospective study at a Level 1 Australasian trauma centre was conducted. Registry-identified patients aged ≥70 years, admitted to hospital with blunt trauma-induced rib fractures, were included. Outcome measures included demographics, pre-morbid function, acute length of stay, intensive care unit admission, injury characteristics, management and complications.

RESULTS

A total of 920 presentations were identified, with 295 meeting the inclusion criteria. Falls accounted for majority (n = 148/295, 50.2%), with a median Injury Severity Score of 10 (inter-quartile range [IQR] 10-14). Severe chest trauma occurred overall in 80% (n = 243/294) and all operative patients (n = 15/15). Conservative management was used in 95% (n = 280/295). Patient-controlled analgesia was common (n = 177/295, 60.0%) and regional techniques increased in the surgical approach (n = 12/15, 80.0%) compared with conservative approach (n = 71/280, 25.4%). Despite longer acute length of stay (12 days, IQR 9-15), operative management resulted in similar complications (26.7% vs. 30.4%) and no deaths. Operative intervention was significantly associated with increased number of fractures (p < 0.001), flail segment (p = 0.001) and higher chest Abbreviated Injury Score (p < 0.001); however, it was not significantly associated with age (p = 0.90), comorbidities (0.91) or anticoagulation (p = 0.51).

CONCLUSION

Surgical management of rib fractures in the elderly was performed without increased complications within this centre's multimodal approach. Standard indications for rib fixation may be applicable in the elderly population, whilst comorbidities, age and anticoagulation use alone may not be adequate reasons to withhold surgical rib fixation.