• J. Am. Coll. Surg. · Feb 2013

    Meta Analysis

    Surgical fixation vs nonoperative management of flail chest: a meta-analysis.

    • Gerard P Slobogean, Cailan Alexander MacPherson, Terri Sun, Marie-Eve Pelletier, and S Morad Hameed.
    • Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. gsloboge@gmail.com
    • J. Am. Coll. Surg. 2013 Feb 1; 216 (2): 302-11.e1.

    BackgroundFlail chest is a life-threatening injury typically treated with supportive ventilation and analgesia. Several small studies have suggested large improvements in critical care outcomes after surgical fixation of multiple rib fractures. The purpose of this study was to compare the results of surgical fixation and nonoperative management for flail chest injuries.Study DesignA systematic review of previously published comparative studies using operative and nonoperative management of flail chest was performed. Medline, Embase, and the Cochrane databases were searched for relevant studies with no language or date restrictions. Quantitative pooling was performed using a random effects model for relevant critical care outcomes. Sensitivity analysis was performed for all outcomes.ResultsEleven manuscripts with 753 patients met inclusion criteria. Only 2 studies were randomized controlled designs. Surgical fixation resulted in better outcomes for all pooled analyses including substantial decreases in ventilator days (mean 8 days, 95% CI 5 to 10 days) and the odds of developing pneumonia (odds ratio [OR] 0.2, 95% CI 0.11 to 0.32). Additional benefits included decreased ICU days (mean 5 days, 95% CI 2 to 8 days), mortality (OR 0.31, 95% CI 0.20 to 0.48), septicemia (OR 0.36, 95% CI 0.19 to 0.71), tracheostomy (OR 0.06, 95% CI 0.02 to 0.20), and chest deformity (OR 0.11, 95% CI 0.02 to 0.60). All results were stable to basic sensitivity analysis.ConclusionsThe results of this meta-analysis suggest surgical fixation of flail chest injuries may have substantial critical care benefits; however, the analyses are based on the pooling of primarily small retrospective studies. Additional prospective randomized trials are still necessary.Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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