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Rib fractures in the elderly population: a systematic review
BACKGROUND: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patient...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9925562/ https://www.ncbi.nlm.nih.gov/pubmed/35137253 http://dx.doi.org/10.1007/s00402-022-04362-z |
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author | Hoepelman, Ruben J. Beeres, Frank J. P. Heng, Marilyn Knobe, Matthias Link, Björn-Christian Minervini, Fabrizio Babst, Reto Houwert, Roderick. M. van de Wall, Bryan J. M. |
author_facet | Hoepelman, Ruben J. Beeres, Frank J. P. Heng, Marilyn Knobe, Matthias Link, Björn-Christian Minervini, Fabrizio Babst, Reto Houwert, Roderick. M. van de Wall, Bryan J. M. |
author_sort | Hoepelman, Ruben J. |
collection | PubMed |
description | BACKGROUND: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates. METHODS: Multiple databases were searched for comparative studies reporting on conservative versus operative treatment for rib fractures in patients older than 60 years. Both observational studies and randomised clinical trials were considered. RESULTS: Five observational studies (n = 2583) were included. Mortality was lower in operatively treated patients compared to conservative treatment (4% vs. 8%). Pneumonia rate and DMV were similar (5/6% and 5.8/6.5 days) for either treatment modality. Overall ILOS and HLOS of stay were longer in operatively treated patients (6.5 ILOS and 12.7 HLOS vs. 2.7 ILOS and 6.5 ILOS). There were only minimal reports on perioperative complications. Notably, the median number of rib fractures (8.4 vs. 5) and the percentage of flail chest were higher in operatively treated patients (47% vs. 39%). CONCLUSION: It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient’s outcome. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-022-04362-z. |
format | Online Article Text |
id | pubmed-9925562 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-99255622023-02-15 Rib fractures in the elderly population: a systematic review Hoepelman, Ruben J. Beeres, Frank J. P. Heng, Marilyn Knobe, Matthias Link, Björn-Christian Minervini, Fabrizio Babst, Reto Houwert, Roderick. M. van de Wall, Bryan J. M. Arch Orthop Trauma Surg Trauma Surgery BACKGROUND: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates. METHODS: Multiple databases were searched for comparative studies reporting on conservative versus operative treatment for rib fractures in patients older than 60 years. Both observational studies and randomised clinical trials were considered. RESULTS: Five observational studies (n = 2583) were included. Mortality was lower in operatively treated patients compared to conservative treatment (4% vs. 8%). Pneumonia rate and DMV were similar (5/6% and 5.8/6.5 days) for either treatment modality. Overall ILOS and HLOS of stay were longer in operatively treated patients (6.5 ILOS and 12.7 HLOS vs. 2.7 ILOS and 6.5 ILOS). There were only minimal reports on perioperative complications. Notably, the median number of rib fractures (8.4 vs. 5) and the percentage of flail chest were higher in operatively treated patients (47% vs. 39%). CONCLUSION: It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient’s outcome. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-022-04362-z. Springer Berlin Heidelberg 2022-02-08 2023 /pmc/articles/PMC9925562/ /pubmed/35137253 http://dx.doi.org/10.1007/s00402-022-04362-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Trauma Surgery Hoepelman, Ruben J. Beeres, Frank J. P. Heng, Marilyn Knobe, Matthias Link, Björn-Christian Minervini, Fabrizio Babst, Reto Houwert, Roderick. M. van de Wall, Bryan J. M. Rib fractures in the elderly population: a systematic review |
title | Rib fractures in the elderly population: a systematic review |
title_full | Rib fractures in the elderly population: a systematic review |
title_fullStr | Rib fractures in the elderly population: a systematic review |
title_full_unstemmed | Rib fractures in the elderly population: a systematic review |
title_short | Rib fractures in the elderly population: a systematic review |
title_sort | rib fractures in the elderly population: a systematic review |
topic | Trauma Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9925562/ https://www.ncbi.nlm.nih.gov/pubmed/35137253 http://dx.doi.org/10.1007/s00402-022-04362-z |
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