Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries

作者：Niloofar Dehghan, Aaron Nauth, Emil H. Schemitsch, Milena Vicente, Richard Jenkinson, Hans J. Kreder, Michael D. McKee, Canadian Orthopaedic Trauma Society and the Unstable Chest Wall RCT Study Investigators, Jérémy Hall, Avery B. Nathens, Andrew Baker, Sandro Rizoli, Brian Pollard, Jennifer Hidy, Christine E. Schemitsch, Paril Suthar, Melanie MacNevin, Syed Morad Hameed, Émilie Joos, Gerard P Slobogean, Shelley Abercromby, Richard Malthaner, Dalilah Fortin, Abdel‐Rahman Lawendy, Deb Lewis, Andrew Furey, Craig Stone, Sarah Anthony, Valisha Keough, Minnie Parsons, Erin Baker, David Stephen, Patrick Henry, Lorraine N. Tremblay, Homer Tien, Katrine Milner, Monica Kunz, Wesley Ghent, Aimee Theriault, Araby Sivananthan, Fathima Adamsahib, Katerina Polihronidis, Mopina Shrikumar, Brad Petrisor, Bill Ristevski, Dale Williams, Paul T. Engels, Jamal Al‐Asiri, Herman Johal, Nicole Simunovic, Jenna Ratcliffe, Jordan Leonard, Sarah Crouch, Hiba Abdul Mannan, Sofia Bzovsky, Matthew Skelly, Francesc Marcano-Fernández, Robert Korley, Paul Duffy, Prism Schneider, Ryan Martin, Richard Buckley, Leah Kennedy, Aftab Akbari, Stephanie S. Yee, Tanja Harrison, Ted Tufescu, Sadeesh Srinathan, Brad Pilkey, Chris Graham, Nigar Sultana, Ramon Angeles, Edward J. Harvey, Gregory Berry, Rudolf Reindl, Max Talbot, Mitchell Bernstein, Kosar Khwaja, Lorenzo Ferri, Tarek Razek, Dan Deckelbaum, Jonathan Spicer, Jeremy Grushka, Andrew Beckett, M. Amedeo, Josie Campisi, Norine Alam, Allan Liew, Steven Papp, Wade Gofton, Karl‐André Lalonde, Guiseppe Pagliarello, Jean Denis Yelle, Julia Foxall, Nicole Evans Harris, Peter A. Cole, Paul M. Lafferty, Sandy Vang, Clifford B. Jones, Terence Endres, Dennis E. Gregory, Donald J. Scholten, Debra L. Sietsema, Jane Walker, Michelle A Padley, Lindsey Behrend, Eduardo Smith‐Singares, Ellen Omi, Diane Lelo, Lisa Chamberlain, Diane Braun, Nicole M Floyd, Drew Fielder, Daniel L. Stahl, Kevin E. Thorpe, Peter Jüni, Bruno R. da Costa, Mohit Bhandari, Jeffrey M. Singh, Mary-Anne Aarts, Kim Madden · 发表于：JAMA Surgery · 年份：2022 · DOI：10.1001/jamasurg.2022.4299 · 被引用次数：76 · 研究领域：Trauma Management and Diagnosis、Pleural and Pulmonary Diseases、Surgical site infection prevention

Importance: Unstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking. Objective: To compare outcomes of surgical treatment of acute unstable chest wall injuries with nonsurgical management. Design, Setting, and Participants: This was a multicenter, prospective, randomized clinical trial conducted from October 10, 2011, to October 2, 2019, across 15 sites in Canada and the US. Inclusion criteria were patients between the ages of 16 to 85 years with displaced rib fractures with a flail chest or non-flail chest injuries with severe chest wall deformity. Exclusion criteria included patients with significant other injuries that would otherwise require prolonged mechanical ventilation, those medically unfit for surgery, or those who were randomly assigned to study groups after 72 hours of injury. Data were analyzed from March 20, 2019, to March 5, 2021. Interventions: Patients were randomized 1:1 to receive operative treatment with plate and screws or nonoperative treatment. Main Outcomes and Measures: The primary outcome was ventilator-free days (VFDs) in the first 28 days after injury. Secondary outcomes included mortality, length of hospital stay, intensive care unit stay, and rates of complications (pneumonia, ventilator-associat...