Evidence map›Paper›PMID 39969627›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025

Surgical rib fixation in patients with cardiopulmonary disease improves outcomes.

Jennie S Kim, Chih Ying Chien, Meghan R Lewis, Elizabeth R Benjamin, Demetrios Demetriades

Abstract read
PubMed Publisher
In one paragraph

Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jennie S KimTrauma, Emergency Surgery and Surgical Critical Care, LA General Medical Center, 2051 Marengo St., IPT C5L100, Los Angeles, CA, 90033, USA.
Chih Ying ChienTrauma, Emergency Surgery and Surgical Critical Care, LA General Medical Center, 2051 Marengo St., IPT C5L100, Los Angeles, CA, 90033, USA.
Meghan R LewisTrauma, Emergency Surgery and Surgical Critical Care, LA General Medical Center, 2051 Marengo St., IPT C5L100, Los Angeles, CA, 90033, USA.
Elizabeth R BenjaminSurgery, Emory University School of Medicine, Atlanta, GA, USA.
Demetrios DemetriadesTrauma, Emergency Surgery and Surgical Critical Care, LA General Medical Center, 2051 Marengo St., IPT C5L100, Los Angeles, CA, 90033, USA. Demetrios.Demetriades@med.usc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe role of rib fixation (RF) in flail chest is debated, and guidelines conditionally recommend RF in highly selected patients. Patients with cardiopulmonary disease (CPD) have traditionally not been deemed surgical candidates. We hypothesize that RF would benefit even high-risk patients with CPD.

methodsAdult patients with isolated flail chest and CPD were identified from the Trauma Quality Improvement Program database (2016-2018). Hospital transfers, patients dead within 72 h, penetrating mechanism, concomitant thoracic aortic injury or cancer were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were in-hospital complications, ventilator days, need for tracheostomy, and length of stay. RF patients were propensity score matched (1:1) to non-operative management (NOM) patients. Multivariate regression identified independent risk factors for outcomes.

resultsIn this 3 year period, 4614 patients were admitted with flail chest and history of CPD. After exclusions and propensity matching, 544 (12%) underwent analysis (RF n = 272, NOM n = 272). RF patients had a lower mortality compared to NOM patients (1.8% vs 5.5%, p = 0.023) but more likely to develop venous thromboembolic events (5.1% vs 1.85%, p = 0.036), prolonged ventilation (28.4% vs 15.1%, p < 0.001), and tracheostomy (15.4% vs 6.6%, p = 0.001). Multivariate analysis showed RF was independently associated with decreased mortality (OR 0.165, 95% CI 0.037-0.735, p = 0.018) while age > 85 years (OR 145.115, 95% CI 9.721-2166.262) and ventilator-associated pneumonia (OR 8.283, 95% CI 1.375-49.888) were associated with increased mortality.

conclusionsRF shows a survival benefit even in high-risk patients with CPD. Patient selection should be individualized but RF should not be excluded based solely on pre-existing conditions.

Indexed as

Flail ChestHeart DiseasesLung DiseasesRib FracturesAdultAgedFemaleHospital MortalityHumansLength of StayMaleMiddle AgedPostoperative ComplicationsPropensity ScoreRespiration, ArtificialRetrospective StudiesCardiorespiratory diseaseFlail chestNon-operative managementOperative rib fixationOutcomes

Identifiers

PMID39969627

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.