Archives of orthopaedic and trauma surgery · 2024
Does the treatment modality affect nosocomial pneumonia and other in-hospital outcomes in patients with combined injuries to the ribs and clavicle? A propensity score weighted analysis of a retrospective cohort.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kobes Tim, van Baal Mark C P M, Heng Marilyn
Аннотация
OBJECTIVE: What is the effect of surgical or conservative treatment on the in-hospital outcomes of patients with combined fractures of the clavicle and ribs?
DESIGN: Retrospective cohort study.
SETTING: Two level-1 trauma centers and academic teaching hospitals in Boston, Massachusetts.
PATIENTS: All adult patients with a clavicle fracture and ≥3 rib fractures admitted from 2016 to 2021.
INTERVENTION: None.
MAIN OUTCOME MEASUREMENTS: Nosocomial pneumonia, hospital length-of-stay (HLOS), ICU length-of-stay (ILOS), days on mechanical ventilation (DMV).
RESULTS: 252 patients were included (212 conservative, 40 surgical; median age 62 years, 67% male). The median ISS and GCS scores were 17 and 15, respectively. Thirty-seven patients developed nosocomial pneumonia. For clavicle fixation (n = 26), the OR for pneumonia was 0.3 (95% CI 0.0-2.2), ILOS had a ß-coefficient of -2.6 (95% CI -5.9-0.8), and DMV a ß-coefficient of -3.6 (95% CI -12.0-4.8). For rib plating (n = 10), the OR for pneumonia was 1.4 (95% CI 0.2-8.6), HLOS had a ß-coefficient of 4.9 (95% CI -1.6-11.5), and ILOS a ß-coefficient of 4.1 (95% CI -0.4-8.6). For both surgeries (n = 4), the CIs were wide.
CONCLUSION: Clavicle fixation in patients with combined injuries of the clavicle and ribs did not improve nor worsen in-hospital outcomes; the orthopedic surgeon should make a patient-tailored treatment decision. Rib plating did not improve in-hospital outcomes in non-flail patients with a concomitant clavicle fracture. Guidelines on non-flail rib plating could profit from these findings in combination with previous and additional research.
LEVEL OF EVIDENCE: Level III, Therapeutic Study.
DESIGN: Retrospective cohort study.
SETTING: Two level-1 trauma centers and academic teaching hospitals in Boston, Massachusetts.
PATIENTS: All adult patients with a clavicle fracture and ≥3 rib fractures admitted from 2016 to 2021.
INTERVENTION: None.
MAIN OUTCOME MEASUREMENTS: Nosocomial pneumonia, hospital length-of-stay (HLOS), ICU length-of-stay (ILOS), days on mechanical ventilation (DMV).
RESULTS: 252 patients were included (212 conservative, 40 surgical; median age 62 years, 67% male). The median ISS and GCS scores were 17 and 15, respectively. Thirty-seven patients developed nosocomial pneumonia. For clavicle fixation (n = 26), the OR for pneumonia was 0.3 (95% CI 0.0-2.2), ILOS had a ß-coefficient of -2.6 (95% CI -5.9-0.8), and DMV a ß-coefficient of -3.6 (95% CI -12.0-4.8). For rib plating (n = 10), the OR for pneumonia was 1.4 (95% CI 0.2-8.6), HLOS had a ß-coefficient of 4.9 (95% CI -1.6-11.5), and ILOS a ß-coefficient of 4.1 (95% CI -0.4-8.6). For both surgeries (n = 4), the CIs were wide.
CONCLUSION: Clavicle fixation in patients with combined injuries of the clavicle and ribs did not improve nor worsen in-hospital outcomes; the orthopedic surgeon should make a patient-tailored treatment decision. Rib plating did not improve in-hospital outcomes in non-flail patients with a concomitant clavicle fracture. Guidelines on non-flail rib plating could profit from these findings in combination with previous and additional research.
LEVEL OF EVIDENCE: Level III, Therapeutic Study.