背景:肋骨骨折(SSRF)的手术稳定与较低的死亡率和较少的并发症相关。这项研究评估了接受SSRF的决定是否与年龄有关,种族,种族,和保险状况,并评估相关的临床结果。
方法:这项回顾性分析包括2016年至2020年在创伤质量改善计划中接受SSRF的年龄≥45岁的肋骨骨折患者。种族,种族,并收集了保险状态。将年龄分为两组:45-64和65。结果包括呼吸机相关性肺炎,计划外气管插管,急性呼吸窘迫综合征,住院死亡率,严重并发症后未能抢救(FTR),和呼吸系统并发症后的FTR。Logistic回归模型适合评估结果,控制性别,身体质量指数,伤害严重程度评分,连击胸,慢性阻塞性肺疾病,充血性心力衰竭,和吸烟。
结果:两千八百三十九名年龄在45-64岁的患者和1828名年龄在65岁以上的患者接受了SSRF。这些组之间的临床结果没有显着差异。分析显示SSRF与呼吸机相关性肺炎,计划外插管,急性呼吸窘迫综合征,住院死亡率,严重并发症后的FTR,呼吸系统并发症后或FTR不因年龄而异(P>0.05)。黑色(比值比[OR]0.67;95%置信区间[CI]:0.59-0.77;P<0.001),西班牙裔(OR0.80;95%CI:0.71-0.91;P<0.001),和医疗补助(OR=0.85;95%CI=0.76-0.95;P=0.005)患者接受SSRF的可能性较小。
结论:在接受SSRF的45-64岁和≥65岁的成年人之间,临床结果没有差异。年龄较大不应排除患者接受SSRF。需要进一步的工作来改善布莱克的利用率不足,西班牙裔和医疗补助患者。
BACKGROUND: Surgical stabilization of rib fractures (SSRF) is associated with lower rates of mortality and fewer complications. This study evaluates whether the decision to undergo SSRF is associated with age, race, ethnicity, and insurance status and assesses associated clinical outcomes.
METHODS: This retrospective analysis included patients ≥45 y old with rib fractures who underwent SSRF in the Trauma Quality Improvement Program from 2016 to 2020. Race, ethnicity, and insurance statuses were collected. Age in years was dichotomized into two groups: 45-64 and 65+. Outcomes included ventilator-associated pneumonia, unplanned endotracheal intubation, acute respiratory distress syndrome, in-hospital mortality, failure to rescue (FTR) after major complications, and FTR after respiratory complications. Logistic regression models were fit to evaluate outcomes, controlling for gender, body mass index, Injury Severity Score, flail chest, chronic obstructive pulmonary disease, congestive heart failure, and smoking.
RESULTS: Two thousand eight hundred thirty-nine patients aged 45-64 and 1828 patients aged 65+ underwent SSRF. No significant difference in clinical outcomes was noted between these groups. Analysis showed that the association of SSRF with ventilator-associated pneumonia, unplanned intubation, acute respiratory distress syndrome, in-hospital mortality, FTR after a major complication, or FTR after a respiratory complication did not vary by age (P > 0.05). Black (odds ratio [OR] 0.67; 95% confidence interval [CI]: 0.59-0.77; P < 0.001), Hispanic (OR 0.80; 95% CI: 0.71-0.91; P < 0.001), and Medicaid (OR = 0.85; 95% CI = 0.76-0.95; P = 0.005) patients were less likely to receive SSRF.
CONCLUSIONS: No differences in clinical outcomes were measured between adults aged 45-64 and ≥65 who underwent SSRF. Older age should not preclude patients from receiving SSRF. Further work is needed to improve underutilization in Black, Hispanic and Medicaid patients.