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PROSPECTIVE SINGLE CENTER PARADIGM SHIFT OF SURGICAL STABILIZATION OF RIB FRACTURES WITH DECREASED LENGTH OF STAY AND OPERATIVE TIME WITH AN INTRATHORACIC APPROACH.

INTRODUCTION
Intrathoracic surgical stabilization of rib fractures (SSRF) allows for a novel approach to rib fracture repair. This approach can help minimize muscle disruption, which may improve patient recovery compared to traditional extrathoracic plating. We hypothesized patients undergoing intrathoracic plating (ITP) to have a shorter length of stay (LOS) and intensive care unit (ICU) LOS compared with extrathoracic plating (ETP).


METHODS
A prospective observational paradigm shift study was performed from November 2017 until September 2021. Patients 18 and older who underwent SSRF were included. Patients with ahead AIS ≥3 were excluded. Patients undergoing ETP (07/2017-10/2019) were compared to ITP (11/2019-09/2021) with Pearson chi-square tests and Mann-Whitney U tests, with the primary outcome being LOS and ICU LOS.


RESULTS
Ninety-six patients were included, 59 (61%) underwent ETP and 37 (38%) underwent ITP. The most common mechanism of injury was motor vehicle collision (29%) followed by falls (23%). There were no differences between groups in age, comorbidities, insurance, discharge disposition and injury severity score (18 vs 19, p = 0.89). ITP had a shorter LOS (10 vs 8 days, p = 0.04) when compared with ETP but no difference in ICU LOS (4 vs 3 days, p = 0.12) and ventilator days. ETP patients more commonly received epidural anesthesia (56% vs 24%, p < 0.001) and intercostal nerve block (56% vs 29%, p = 0.01) compared to ITP. However, there was no difference in median morphine equivalents between cohorts. Operative time was shorter for ITP with ETP (279 vs 188 minutes, p < 0.001) after adjusting for numbers of ribs fixed.


CONCLUSION
In this single center study, patients who underwent ITP had a decreased LOS and operative time in comparison to ETP in patients with similar injury severity. Future prospective multicenter research is needed to confirm these findings and may lead to further adoption of this minimally invasive technique.


LEVEL OF EVIDENCE
Therapeutic/care management level IV.