National readmission rates after surgical stabilization of traumatic rib fractures

Abstract

Introduction: Little is known about the risk of readmission after surgical stabilization of rib fractures (SSRFs). Materials and Methods: We performed a retrospective analysis of the National Readmissions Database, a representative sample of all hospitalized patients in the US, from January 2012 to December 2014. All inpatient encounters with a primary trauma diagnosis of rib fractures were included in the study. Patients who underwent SSRF were compared to those who did not. Outcomes evaluated included readmission frequency and mortality. Results: There were 411,169 patients admitted after trauma with rib fractures from 2012 to 2014; of these, 382 (<1%) underwent SSRF. Among non-SSRF patients, ≥3 rib fractures (odds ratio = 1.41, 95% confidence interval 1.23–1.62) were associated with readmission. Compared to the non-SSRF group, patients undergoing SSRF had a greater incidence of flail chest (26% vs. 2%; P < 0.0001), were more likely to have an injury severity score >15 (55% vs. 37%; P < 0.0001), and more likely to have a coexisting diagnosis of respiratory failure (35% vs. 18%, P < 0.0001). Despite the increased severity of injury among patients having SSRF, there was neither a statistically significant increase in patient deaths (<1% for SSRF vs. 4% no SSRF, P = 0.03) nor readmissions (<1% for SSRF vs. 1% for non SSRF, P = 1.0). Conclusions: Long-term readmission rates for traumatic rib fracture patients are low. If nonoperative management is pursued, the presence of ≥3 rib fractures increases the risk of readmission. Patients requiring SSRF do not have higher readmission or mortality rates despite having a higher burden of injury during their initial hospitalization, suggesting the clinical benefit of surgical fixation.