Quality of life and clinical outcomes of operatively treated patients with flail chest injuries: A multicentre prospective cohort study

Ruben J Hoepelman; Fabrizio Minervini; Frank J P Beeres; Bas van Wageningen; Frank F IJpma; Nicole M van Veelen; Koen W W Lansink; Jochem M Hoogendoorn; Mark C P van Baal; Rolf H H Groenwold; Roderick M Houwert; NEXT study group

doi:10.3389/fsurg.2023.1156489

Quality of life and clinical outcomes of operatively treated patients with flail chest injuries: A multicentre prospective cohort study

Front Surg. 2023 Mar 15:10:1156489. doi: 10.3389/fsurg.2023.1156489. eCollection 2023.

Affiliations

¹ Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
² Department of Thoracic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
³ Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
⁴ Department of Trauma Surgery, Radboud University Medical Center Utrecht, Nijmegen, Netherlands.
⁵ Department of Trauma Surgery, University Medical Center Groningen, Groningen, Netherlands.
⁶ Department of Trauma Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands.
⁷ Department of Trauma Surgery, Haaglanden Medical Center, Hague, Netherlands.
⁸ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
⁹ Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Introduction: Most studies about rib fractures focus on mortality and morbidity. Literature is scarce on long term and quality of life (QoL) outcomes. Therefore, we report QoL and long-term outcomes after rib fixation in flail chest patients.

Methods: A prospective cohort study of clinical flail chest patients admitted to six level 1 trauma centres in the Netherlands and Switzerland between January 2018 and March 2021. Outcomes included in-hospital outcomes and long-term outcomes, such as QoL measurements 12 months after hospitalization using the EuroQoL five dimensions (EQ-5D) questionnaire.

Results: Sixty-one operatively treated flail chest patients were included. Median hospital length of stay was 15 days and intensive care length of stay was 8 days. Sixteen (26%) patients developed pneumonia and two (3%) died. One year after hospitalization the mean EQ5D score was 0.78. Complication rates were low and included hemothorax (6%) pleural effusion (5%) and two revisions of the implant (3%). Implant related irritation was commonly reported by patients (n = 15, 25%).

Conclusions: Rib fixation for flail chest injuries can be considered a safe procedure and with low mortality rates. Future studies should focus on quality of life rather than solely short-term outcomes.Trial registration: Registered in the Netherlands Trial Register NTR6833 on 13/11/2017 and the Swiss Ethics Committees Registration Number 2019-00668.

Keywords: flail chest; quality of life; rib fixation; rib fracture; thoracic trauma.

Grants and funding

This work was financially supported by the DePuy Synthes (grant number DPS-TCMF-2017-036). The organization was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All researchers are independent from the funder. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.