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Early Thoracic Surgery Consultation Reduces Length of Stay for Severely Displaced Rib Fractures
*Fariha Sheikh, *Kayla A. Fay, *Ian C. Bostock, Kurt Rhynhart, *Timothy M. Millington, *D. Joshua Mancini, *David J. Finley, *Joseph D. Phillips
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: We sought to evaluate our experience with surgical fixation to determine if thoracic surgeons should become involved earlier in treating these injuries.
Design: Review of all patients who underwent rib fixation from April 2011-January 2017.
Setting: Level one trauma center.
Patients: All those who underwent rib fixation.
Interventions: Early rib fixation.
Main Outcome Measures: Patients were evaluated for demographics, severity of injury, days from injury to consult and to surgery, extubation, post-operative and hospital length of stay (LOS), and complications.
Results: Forty patients underwent surgical fixation; 11 had respiratory failure and 11 met criteria for flail chest. Fractures were acute in 32 patients and 8 had chronic, non-healing fractures. Median days from acute injury to thoracic consult was 3 (range 0 to 30). Patients who received a thoracic consult within 4 days of injury had significantly shorter time from injury to surgery (5 vs 15 days; p<0.001) and hospital LOS (10.7 vs 21.4 days; p<0.05). There was no difference in severity of injury by Revised Trauma Score, days from thoracic consult to surgery, number of ribs fractured or plated, post-operative time to extubation, post-operative LOS, or complications associated with surgery.
Conclusions: In patients who require operative intervention for multiple severely displaced rib fractures early thoracic surgery consultation results in shorter time from injury to surgery and correspondingly shorter LOS. This suggests that early involvement of thoracic surgeons in the management of multiple, severely displaced rib fractures leads to shorter hospital stay and likely more efficient use of healthcare resources.

Early vs. Late Operative Intervention for Rib Fixation
Early Thoracic Consult (mean)Later Thoracic Consult (mean)p value
Age (years)57590.75
Number of Ribs Fractured7.87.10.56
Revised Trauma Score7.57.40.92
Injury to Surgery (days)5.115.1<0.001
Consult to Surgery (days)3.530.68
Number of Ribs Plated3.430.42
Post-op Extubation (days)1.10.70.68
Length of Stay Post-op (days)6.611.50.19
Length of Stay Total (days)10.721.40.04


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