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- Title
Surgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials.
- Authors
Ferreira, Rafael Oliva Morgado; Pasqualotto, Eric; Viana, Patrícia; Schmidt, Pedro Henrique Siedschlag; Andrighetti, Leonardo; Chavez, Matheus Pedrotti; Flausino, Felippe; de Oliveira Filho, Getúlio Rodrigues
- Abstract
Purpose: Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment. Methods: Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I2 statistics. Results: Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD − 4.34, 95% CI – 6.98, − 1.69; p < 0.01; I2 = 87%; GRADE: very low; PI − 13.51, 4.84); length of intensive care unit stay (WMD − 4.62, 95% CI − 7.19, − 2.05; p < 0.01; I2 = 78%; GRADE: low; PI − 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I2 = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I2 = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD − 5.39, 95% CI − 11.38, − 0.60; p = 0.08; I2 = 89%; GRADE: very low; PI − 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I2 = 54%; GRADE: moderate; PI 0.11, 3.24) was found. Conclusions: Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.
- Subjects
CONSERVATIVE treatment; ONLINE information services; MEDICAL databases; LENGTH of stay in hospitals; INTENSIVE care units; PNEUMONIA; TRACHEOTOMY; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; FLAIL chest; SYSTEMATIC reviews; CHEST injuries; TREATMENT effectiveness; ARTIFICIAL respiration; FRACTURE fixation; DESCRIPTIVE statistics; RIB fractures; MEDLINE; DATA analysis software; EMERGENCY medicine; DISEASE complications
- Publication
European Journal of Trauma & Emergency Surgery, 2023, Vol 49, Issue 6, p2531
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-023-02339-0