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The where, when, and why of surgical rib fixation: Utilization patterns, outcomes, and readmissions

      Highlights

      • Patients with rib fractures managed with SSRF have similar rates of readmissions and complications of non-operatively managed patients.
      • Surgical stabilization of rib fractures (SSRF) utilization varies widely across institutions.
      • Predictor for risk of SSRF was admission to hospital considered high volume center for rib fixation.

      Abstract

      Introduction

      There has been increasing use of surgical stabilization of rib fractures (SSRF), but most literature demonstrate outcomes of single centers during the index hospitalization. We sought to analyze statewide patterns and longer-term outcomes after SSRF.

      Methods

      Adult patients with >1 rib fracture in the 2016–2018 California Office of Statewide Health Planning Database were identified. SSRF and non-operatively managed (NO) patients were matched on clinical and demographic variables. Patterns and outcomes of SSRF were assessed with multivariate modeling.

      Results

      599 SSRF patients were matched to 1191 NO patients. Readmission and readmission complication rates were similar between the groups. In a competing risks regression, admission to a high-volume SSRF center (SHR 4.6, CI95 4.0–5.4, p = 0.01) was the primary predictor of SSRF. 30-day mortality adjusted risk was lower for the SSRF vs. NO group (HR 0.47, CI 0.25–0.88, p = 0.02).

      Discussion

      Statewide utilization of SSRF varied widely and appears to be driven by center or surgeon characteristics rather than clinical factors. Efforts to expand access to SSRF based on clinical factors may be warranted.

      Keywords

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