Fixation of rib fractures is beneficial for patients with chronic obstructive pulmonary disease, a trauma quality improvement program study

Abstract

Abstract Background Internal fixation for multiple rib fractures is well established. Patients with underlying chronic obstructive pulmonary disease (COPD) have a higher rate of perioperative complications. It is unclear if these patients are suitable candidates for internal fixation and if surgical interventions are harmful to these patients. Study Design and methods Adult patients with ≥ 3 rib fractures and underlying COPD from the Trauma Quality Improvement Program between 2017 and 2019 were eligible for inclusion. The patients were divided into two treatment groups: operative and non-operative. Furthermore, inverse probability treatment weighting was applied to analyze mortality and adverse hospital events. Results Patients with COPD in the operative group had higher ventilator use (odds ratio [OR], 3.211; 95% confidence interval [CI], 1.993–5.175; p < 0.001). Additionally, they had a longer length of stay (coefficient β, 4.139; standard error, 0.829; p < 0.001) and longer ventilator days (coefficient β, 1.937; standard error, 0.655; p = 0.003) than in the non-operative group. Furthermore, the mortality rate was lower in the operative group than in the non-operative group (OR, 0.426; 95% CI, 0.228–0.798; p = 0.008). Conclusion Internal fixation of rib fractures plays a crucial role in patients with underlying COPD disease. They presented a better mortality rate without an increased perioperative complication rate.

Keywords

• Rib fracture
• Internal fixation
• Chronic obstructive pulmonary disease