Postoperative outcomes following surgical stabilization of rib fractures stratified by 5-factor modified frailty index

Abstract

Objectives: Surgical stabilization of rib fractures (SSRF) improves outcomes in patients with flail chest and displaced fractures with impaired pulmonary function. Elderly and frail patients with such injuries are at risk for significant morbidity and may benefit from SSRF. The 5-factor modified frailty index (mFI-5) is a validated predictor of postoperative outcomes. The purpose of this study is to evaluate the relationship between frailty and outcomes following SSRF at a tertiary care trauma center. Methods: A retrospective review of patients undergoing SSRF from 2015 to 2019. Patients over 18 years old with two or more displaced fractures were included in the study. Exclusion criteria were isolated fracture, traumatic brain injury, and pulmonary contusion. Frail patients were defined by an mFI-5 score 2 or greater. Chi-square analysis, Fischer's exact test, and Student's t-test were used for comparative analysis as appropriate. P < 0.05 was considered statistically significant. Results: One hundred and fifty-four patients met inclusion criteria. Forty-eight patients were designated frail and 106 nonfrail. The mean number of fractures was similar between frail and nonfrail groups (7.0 vs. 7.3, P = 0.685). Injury Severity Score was lower in the frail group (14.5 vs. 17.8, P = 0.02). Inpatient mortality (P = 0.312), rates of pneumonia, end-organ dysfunction, and surgical site infections were similar (P > 0.05). Intensive care unit admission (47.9% vs. 29.2%, P = 0.025) and tracheostomy rates (P = 0.009) were increased in the frail group. Frailty also increased the risk of prolonged mechanical ventilation >48 h on multivariate analysis. Conclusion: Frail patients, stratified using mFI 5 score, experienced similar rates of multiple postoperative outcomes, including mortality, but had increased rates of prolonged ventilation and tracheostomy. Despite observed but expected increased morbidity in these patients, the similar complication and mortality rates suggest a role for surgical stabilization of severe rib fractures in frail patients.