Surgical stabilization of rib fractures in the geriatric trauma population is associated with equivalent outcomes to a younger cohort: A propensity matched analysis

Stephanie Jensen; Van Christian Sanderfer; Kierstin Porter; Madeline G Rieker; Brianna R Maniscalco; Jenna Lloyd; Robert Gallagher; Huaping Wang; Sam Ross; Cynthia Lauer; Kyle Cunningham; Bradley Thomas

doi:10.1016/j.injury.2024.111593

Surgical stabilization of rib fractures in the geriatric trauma population is associated with equivalent outcomes to a younger cohort: A propensity matched analysis

Injury. 2024 May 3;55(7):111593. doi: 10.1016/j.injury.2024.111593. Online ahead of print.

Authors

Affiliations

¹ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Stephanie.Jensen@atriumhealth.org.
² Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Van.Sanderfer@atriumhealth.org.
³ Des Moines University Medical School, 3200 Grand Ave, Des Moines, IA 50312, United States of America. Electronic address: Kierstin.L.Porter@dmu.edu.
⁴ Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, United States of America. Electronic address: mgrieker@wakehealth.edu.
⁵ Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, United States of America. Electronic address: bmanisca@wakehealth.edu.
⁶ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Jenna.Lloyd@atriumhealth.org.
⁷ Des Moines University Medical School, 3200 Grand Ave, Des Moines, IA 50312, United States of America. Electronic address: Robert.Gallagher@dmu.edu.
⁸ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Huaping.Wang@atriumhealth.org.
⁹ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Samuel.Ross@atriumhealth.org.
¹⁰ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Cynthia.Lauer@atriumhealth.org.
¹¹ Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Kyle.Cunningham@atriumhealth.org.
¹² Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America. Electronic address: Bradley.Thomas@atriumhealth.org.

PMID: 38762943
DOI: 10.1016/j.injury.2024.111593

Abstract

Background: Surgical stabilization of rib fractures (SSRF) improves outcomes in chest wall trauma. Geriatric patients are particularly vulnerable to poor outcomes; yet, this population is often excluded from SSRF studies. Further delineating patient outcomes by age is necessary to optimize care for the aging trauma population.

Methods: A retrospective cohort study was conducted examining outcomes among patients aged 40+ for whom an SSRF consult was placed between 2017 and 2022 at a level 1 trauma center. Patients were categorized into geriatric (65+) and adult (40-64), as well as 80 years and older (80+) and 79 and younger (40-79). Patient outcomes were assessed comparing non-operative and operative management of chest wall trauma. Propensity matched analysis was performed to evaluate mortality differences between adult and geriatric patients who did and did not undergo SSRF.

Results: A total of 543 patients had an SSRF consult. Of these, 227 were 65+, and 73 were 80+. A total of 129 patients underwent SSRF (24 %). The percentage of patients undergoing SSRF did not vary between 40 and 64 and 65+ (23.7 % and 23.6 %, respectively, p = 0.97) or 40-79 and 80+ (24.0 vs 21.9, p = 0.69). Patients undergoing SSRF had higher chest injury burden and were more likely to require mechanical ventilation and ICU level care on admission. Overall, in-hospital mortality rate was 4.6 %. Among patients who underwent SSRF, mortality rate did not significantly differ between 65+ and 40-64 (7.8% vs 2.7 %, p = 0.18) or 80+ and 40-79 (6.3% vs 4.6 %, p = 0.77). This remained true in propensity matched analysis.

Conclusion: Geriatric and octogenarian patients with rib fractures underwent SSRF at similar rates and achieved equivalent outcomes to their younger counterparts. SSRF did not differentially affect mortality outcomes based on age group in propensity matched analysis. SSRF is safe for geriatric patients including octogenarians.

Keywords: Geriatric trauma; Rib fractures; Surgical stabilization of rib fractures.