In- and out-of-hospital outcomes following surgical stabilization of rib fractures in 80 years and older: a single-institution experience

The incidence of rib fractures has been reported in up to 10% of trauma patients of which one-third will have associated pulmonary complications [1]. Rib fractures and severe chest wall injury (CWI) are particularly harmful to the elderly. Post-injury complication rates are elevated in geriatric patients who sustain CWI including higher likelihood of pneumonia, pleural space complications, intensive care utilization, and up to double the mortality compared to younger populations [2]. Poor outcomes may be even more pronounced in those patients aged 80 years and older [3]. Strategies to mitigate this risk include appropriate disposition, protocolized therapy including multi-modal pain control and pulmonary toilet, and consideration of surgical stabilization should non-operative treatment fail [4].

There has been evidence and even a practice guideline to support surgical stabilization of rib fractures (SSRF) for severe fracture patterns in both young and elderly trauma patients [4,5,6]. There is also mounting evidence for improved outcomes in terms of pain control and narcotic consumption in patients without flail chest [7]. For elderly patients over the age of 65 undergoing surgical stabilization of rib fractures (SSRF) there is a reported mortality benefit in addition to decreased rates of ventilator-associated pneumonia, intensive care unit length of stay, and decreased hospital length of stay [8,9,10]. A recent publication described the rib fracture frailty index (RFF Index) which is a risk stratification tool for geriatric patients (> 65 years of age) with multiple rib fractures to assist in clinical decision making for operative intervention [11]. Of particular interest, a multi-center retrospective review of patients aged 80 years or older undergoing SSRF for severe CWI found surgical fixation to confer a lower relative risk of mortality and diminished narcotic usage as compared to non-surgical treatment [3]. While this was primarily aimed at inpatient outcomes, we sought to describe the trajectory of this at-risk patient population following SSRF with a focus on mortality (inpatient and 90-day) and narcotic usage (discharge and 30-day outpatient). We hypothesize that outpatient mortality would be increased as compared to inpatient mortality and that low rates of narcotic use at outpatient follow-up would be appreciated.

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