背景:肋骨骨折(SSRF)的手术稳定越来越多,然而,在伤前抗血栓治疗期间接受SSRF治疗的患者的结局仍然未知.我们比较了接受和未接受抗血栓治疗的患者的手术变量和结果。我们假设损伤前抗凝治疗与SSRF延迟和不良预后相关。
方法:对于这项回顾性队列研究,我们查询了胸部损伤国际数据库,2018年8月至2022年3月期间接受SSRF的患者。抗血栓治疗分为抗血小板和抗凝治疗。主要结果是从入院到SSRF的时间。次要结果包括SSRF持续时间和并发症。数值数据以中位数(IQR)表示,分类数据为数字(%)。使用逆概率加权来控制混杂。
结果:纳入了118名SSRF患者,25例(11%)接受抗血栓治疗。这些患者年龄较大(72岁,(65-80岁)与57岁,(43-66);p<0.001),ISS较低(14,(10-20)对21,(14-30);p=0.002)。从入院到SSRF的时间相当(2天,(1-4)与2天,(1-4);p=0.37)手术时间(154分钟,(120.0-212.0)与177分钟相比,(143.0-210.0);p=0.34)。使用抗血栓药物的患者无ICU天数较少(24(22-26)对28(23-28);p=0.003),但无呼吸机天数较多(28,(28-28)对27(27-28);p<0.008)。在调整混杂因素后,伤前抗凝与延迟SSRF(相对风险,RR=1.37,95%CI0.30-6.24),手术时间(RR=1.07,95%CI0.88-1.31),IFD<=28(RR=2.05,95CI:0.33-12.67),VFD<=27(RR=0.71,95CI:0.15-3.48)或并发症(RR=0.55,95%CI0.06-5.01)。
结论:在需要SSRF的患者中,伤前抗栓药物的使用既不会延迟SSRF,也不会影响手术时间,也不会增加并发症的风险。我们的数据表明,在伤前使用抗凝药的患者中,可以安全地进行SSRF。
方法:IV.
方法:治疗/护理管理。
BACKGROUND: Surgical stabilization of rib fractures (SSRF) is increasingly performed, however the outcome of patients undergoing SSRF while on pre-injury antithrombotic therapy remains unknown. We compared surgical variables and outcomes of patients who were and were not on antithrombotic therapy. We hypothesize pre-injury anticoagulation is associated with delay in SSRF and worse outcomes.
METHODS: For this retrospective cohort study, we queried the Chest Injury International Database, for patients undergoing SSRF between 08/2018 and 03/2022. Antithrombotic therapy was categorized into antiplatelet and anticoagulant use. Primary outcome was time from admission to SSRF. Secondary outcomes included SSRF duration and complications. Numerical data were presented as median (IQR), categorical data as number (%). Inverse probability weighting was used to control for confounding.
RESULTS: Two hundred and eighteen SSRF patients were included, 25 (11 %) were on antithrombotic therapy. These patients were older (72 years, (65-80) versus 57 years, (43-66); p < 0.001) with lower ISS (14, (10-20) versus 21, (14-30); p = 0.002). Time from admission to SSRF was comparable (2 days, (1-4) versus 2 days, (1-4); p = 0.37) as was operative time (154 mins, (120.0-212.0) versus 177 mins, (143.0-210.0); p = 0.34). Patients using antithrombotics had fewer ICU-free days (24 (22-26) versus 28 (23-28); p = 0.003) but more ventilator free days (28, (28-28) versus 27 (27-28); p < 0.008). After adjusting for confounding, pre-injury anticoagulation was not significantly associated with delayed SSRF (Relative Risk, RR=1.37, 95 % CI 0.30-6.24), operative time (RR=1.07, 95 % CI0.88-1.31), IFD <=28 (RR=2.05, 95 %CI:0.33-12.67), VFD<=27 (RR=0.71, 95 %CI:0.15-3.48) or complications (RR=0.55, 95 % CI0.06-5.01).
CONCLUSIONS: Pre-injury antithrombotic drug use neither delayed SSRF nor impacted operative time in patients requiring SSRF and was not associated with increased risk of complications. Our data suggest SSRF can be safely performed without delay in patients who use anticoagulation pre-injury.
METHODS: IV.
METHODS: Therapeutic/care management.