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European Journal of Trauma and Emergency Surgery

Erschienen in:

02.09.2020 | Original Article

Long-term quality of life and functional outcome after rib fracture fixation

verfasst von: Jesse Peek, Valerie Kremo, Reinier Beks, Nicole van Veelen, Alfred Leiser, Björn-Christian Link, Roderick M. Houwert, Fabrizio Minervini, Matthias Knobe, Reto H. Babst, Frank J. P. Beeres

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2022

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Abstract

Purpose

The primary aim of this study was to assess the long-term quality of life and functional outcome after rib fracture fixation for patients with multiple rib fractures or flail chest. Secondarily, this study sought to identify risk factors associated with the quality of life.

Methods

A retrospective cohort study with a follow-up by questionnaire was performed at a level-1 trauma center in Switzerland. All adult patients with three or more rib fractures treated with rib fixation between 2010 and 2018 were eligible for inclusion. All outcomes were independently assessed for patients with multiple rib fractures and patients with a flail chest. The outcome measures were quality of life, level of dyspnea, return to work, implant irritation, and implant removal after a minimum of 12 months of follow-up. Quality of life was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) and level of dyspnea was determined with the modified Medical Research Council dyspnea (mMRC) scale.

Results

The survey was completed by 74 out of 102 patients (73%) at a median follow-up of 26 months (IQR 15–37). The median EQ-5D utility index score was 0.91 (0.89–1.0), which was equivalent to the reference population (0.902, p = 0.523). The vast majority of patients experienced ‘no problems’ or ‘slight problems’ in any of the EQ-5D-5L dimensions. The complication rate associated with rib fracture fixation was low, implant-related irritation was the most common long-term sequela and occurred in 31% of patients. In multivariable regression analyses, total length of stay on the intensive care unit (ICU-LOS) was independently associated with a worse quality of life.

Conclusions

Patients who underwent rib fracture fixation for multiple rib fractures or flail chest after severe chest trauma experienced a good quality of life at least 1 year after surgery. A longer ICU-LOS was independently associated with impaired quality of life. In addition, there were no significant differences in the long-term quality of life and functional outcome between patients with multiple rib fractures and a flail chest. Implant-related irritation was the most important long-term sequela and occurred in one-third of patients.

Nur mit Berechtigung zugänglich

Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25(1):1–6. https://doi.org/10.1186/s13049-017-0384-y.CrossRef

Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975–9. https://doi.org/10.1097/00005373-199412000-00018.CrossRefPubMed

Baker E, Xyrichis A, Norton C, Hopkins P, Lee G. The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review. Scand J Trauma Resusc Emerg Med. 2018;26(1):67. https://doi.org/10.1186/s13049-018-0535-9.CrossRefPubMedPubMedCentral

Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, Gamelli RL. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23. https://doi.org/10.1016/j.surg.2005.07.022.CrossRefPubMed

Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46(1):61–5. https://doi.org/10.1016/j.injury.2014.06.014.CrossRefPubMed

Shelat VG, Eileen S, John L, Teo LT, Vijayan A, Chiu MT. Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012;38(4):451–5. https://doi.org/10.1007/s00068-012-0186-x.CrossRefPubMed

Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014;207(5):659–62. https://doi.org/10.1016/j.amjsurg.2013.12.012.CrossRefPubMed

Peek J, Beks RB, Kremo V, Van Veelen N, Leiser A, Marijn RM, Link B-C, Knobe M, Babst H, Beeres FJP. The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest a retrospective study and systematic review of the current evidence. Eur J Trauma Emerg Surg. 2019. https://doi.org/10.1007/s00068-019-01274-3 (Online ahead of print).CrossRefPubMed

Beks RB, Peek J, de Jong MB, Wessem KJP, Öner CF, Hietbrink F, Leenen LPH, Groenwold RHH, Houwert RM. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45(4):631–44. https://doi.org/10.1007/s00068-018-1020-x.CrossRefPubMed

10.

Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, Bosarge PL, Love J, Haut ER, Como JJ. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern association for the surgery of trauma. J Trauma Acute Care Surg. 2017;82(3):618–26. https://doi.org/10.1097/TA.0000000000001350.CrossRefPubMed

11.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. https://doi.org/10.1016/j.ijsu.2014.07.013.CrossRef

12.

Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad M, Borens O, Kates S, Morgenstern M. Infection after fracture fixation: current surgical and microbiological concepts. Injury. 2018;49(3):511–22. https://doi.org/10.1016/j.injury.2016.09.019.CrossRefPubMed

13.

van Reenen M, Janssen B, Stolk E, BOye S, Herdman M, Kennedy-Martin M, et al. EQ-5D-5L User Guide, 2019. Available from: https://euroqol.org/publications/user-guides. Accessed 18 Feb 2020.

14.

Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–43. https://doi.org/10.3109/07853890109002087.CrossRefPubMed

15.

Herdman M, Gudex C, Lloyd A, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36. https://doi.org/10.1007/s11136-011-9903-x.CrossRefPubMedPubMedCentral

16.

Mahler D, Wells C. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93(3):580–6. https://doi.org/10.1378/chest.93.3.580.CrossRefPubMed

17.

Hulsmans MHJ, van Heijl M, Frima H, van der Meijden OAJ, van den Berg HR, van der Veen AH, Gunning AC, Houwert RM, Verleisdonk EJMM. Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures. Eur J Trauma Emerg Surg. 2018;44(4):581–7. https://doi.org/10.1007/s00068-017-0848-9.CrossRefPubMed

18.

Peek J, Beks RB, Hietbrink F, Heng M, De Jong MB, Beeres FJP, Leenen LPH, Groenwold HH, Houwert RM. Complications and outcome after rib fracture fixation: a systematic review. J Trauma Acute Care Surg. 2020. https://doi.org/10.1097/TA.0000000000002716 (Online ahead of print).CrossRefPubMed

19.

Beks RB, de Jong MB, Houwert RM, et al. Long-term follow-up after rib fixation for flail chest and multiple rib fractures. Eur J Trauma Emerg Surg. 2019;45(4):645–54. https://doi.org/10.1007/s00068-018-1009-5.CrossRefPubMed

20.

Caragounis E-C, Fagevik Olsen M, Pazooki D, Granhed H. Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study. World J Emerg Surg. 2016;14(11):27. https://doi.org/10.1186/s13017-016-0085-2.CrossRef

21.

Mayberry JC, Kroeker AD, Ham LB, Mullins RJ, Trunkey DD. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg. 2009;75(5):389–94.CrossRefPubMed

22.

Walters ST, Craxford S, Russell R, Khan T, Nightingale J, Moran CG, et al. Surgical stabilization improves 30-day mortality in patients with traumatic flail chest: a comparative case series at a major trauma center. J Orthop Trauma. 2019;33(1):15–22. https://doi.org/10.1097/BOT.0000000000001344.CrossRefPubMed

23.

Marasco SF, Martin K, Niggemeyer L, Summerhayes R, Fitzgerald M, Bailey M. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury. 2019;50(1):119–24. https://doi.org/10.1016/j.injury.2018.11.005.CrossRefPubMed

24.

Dhillon TS, Galante JM, Salcedo ES, Utter GH. Characteristics of chest wall injuries that predict postrecovery pulmonary symptoms: a secondary analysis of data from a randomized trial. J Trauma Acute Care Surg. 2015;79(2):179–87. https://doi.org/10.1097/TA.0000000000000718.CrossRefPubMed

Titel: Long-term quality of life and functional outcome after rib fracture fixation
verfasst von: Jesse Peek
Valerie Kremo
Reinier Beks
Nicole van Veelen
Alfred Leiser
Björn-Christian Link
Roderick M. Houwert
Fabrizio Minervini
Matthias Knobe
Reto H. Babst
Frank J. P. Beeres
Publikationsdatum: 02.09.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 1/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01470-6

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Long-term quality of life and functional outcome after rib fracture fixation