Über den instabilen Thorax - Auswertung des Patientenoutcomes eines überregionalen Traumazentrums

According to the current study situation, compared to conservative therapy, the operative stabilization of flail chest (FC) can improve patient outcomes and reduce mortality. This retrospective study therefore analyzes the injury patterns as a result of thoracic trauma, in particular with flail chest, its various therapy options and their outcome. It describes the characteristics of patients hospitalized in the university medical center of Aachen between January 2012 and April 2021 due to blunt chest trauma. The 570 included patients have a minimum age of 18 and suffered from sternum fractures, serial rib fractures, (3 rib fractures) and/or an FC (= 3 ribs in at least 2 places fractured). The rib osteosynthesis cohort (RO) included 58 patients. The non-operated (NO) cohort consisted of 512 patients who received conservative therapy. Primary outcomes were intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS) and ventilation time. Secondary outcomes included intricacies such as pneumonia, sepsis and tracheotomy. Although the results of our very heterogeneous cohorts (i.a. missing Injury Severity Scores (ISS)) showed a significantly poorer outcome in the RO cohort, subgroup analyses with more homogeneous cohorts could show, that ventilated patients with FC had a similar outcome in both cohorts. Furthermore, preoperatively ventilated patients benefited from a shorter time to surgery (TTS) ≤ 3 days. Their total ventilation time tended to be shorter (524,6 h vs. 559,4 h, p = 0,872) and pneumonia (55,6 % vs. 83,3 %, p = 0,121) and the need for tracheostomy (55,6 % vs. 72,2 %, p = 0,386) were less common. Patients without preoperative ventilation but with pulmonary contusion did not seem to benefit from a shorter TTS. Our results conform with some retrospective studies while there are other prospective and retrospective studies showing a significant benefit of surgical chest wall stabilization. This could be explained by the patients in our RO cohort having had more severe injury patterns ...