Comparison of In-Hospital Outcomes of Surgical Stabilization of Rib Fractures with Nonsurgical Management: A Multicenter, Prospective, Cohort Study.

Background: Evidence for the efficacy of surgical stabilization of rib fractures in patients with rib fractures is controversial. Objective: We aim to compare the clinical outcomes of surgical rib fixation for rib fracture with non-operative treatment. Methods: Our institutional database from three general hospitals (Viet Duc Hospital, Viet Tiep Friendship Hospital & Cho Ray Hospital) was queried to identify patients with flail chest treated with locked plate fixation between December 2021 and February 2023. A medical record review for demographic, injury, hospital, and surgical data was also retrospectively performed for all patients. Characteristics and outcomes of the patients receiving the surgical rib fixation for rib fracture were compared with those without surgery. Results: A total of 166 patients with thoracic trauma were included. The majority of patients were male, and the age range was from 18 to 80 years old, with a mean age of 51.6 years. 52 (31.3%) underwent surgical stabilization of rib fractures (SSRF). The highest combined injuries were limb injuries, followed by traumatic brain injury, and maxillofacial trauma. While 1 patient died in the non-surgical group, there was no significant difference in the mortality between the two groups. The surgical group had a slightly shorter hospital stay than the non-surgical group (8.6 days vs. 10.0 days, p-value: 0.038). SSRF group tended toward a lower incidence of pneumonia compared to the non-surgical group (SSRF: 3.8% vs. non-surgical: 7%), but this difference was not statistically significant (p-value: 0.426). SSRF group also had a lower incidence of tracheostomy than the non-operative group (SSRF: 0% vs. non-surgical: 1.8%, p-value: 0.337). Conclusion: Operative fixation of a rib fracture in trauma patients resulted in a lower incidence of pneumonia, fewer days of mechanical ventilation, and a shorter hospital stay compared to non-operative treatment group.

Mortality risk factors in patients on waiting list for lung transplantation between 2005 and 2018: A single institutional experience.

BACKGROUND: Lung transplantation is a therapeutic option for patients with end-stage lung disease. However, the increase in organ demand has surpassed the number of donors, with many patients unable to outlive the long waiting period. This study aimed to assess mortality and its risk factors in patients on the waiting list for lung transplantation in a single medical centre. METHODS: All evaluated clinical and laboratory data of the patients with end-stage lung disease assessed for lung transplantation between February 2005 and November 2018 in National Taiwan University Hospital were recorded in the waiting list database. The patients in this study were divided into two groups: survival and death groups. RESULTS: Between February 2005 and November 2018, 169 patients were enrolled in the waiting list. Thirty-one patients were alive and waiting for the chance of lung transplantation, 56 underwent lung transplantation, and 82 died while waiting. The mean age of all patients was 43.7 years, and 91 were women. The mean body mass index (BMI) was 20.3. The most common blood type was type O. All patients were in New York Heart Association (NYHA) class III or IV. After analysis of the two groups, lower BMI presented as a mortality factor. CONCLUSION: This is the first Taiwanese study to describe the mortality factors in patients waiting for lung transplantation. The main factors influencing the survival of these patients were lower BMI, NYHA class IV, and diseases which cause end-stage lung diseases (infection and pulmonary fibrosis).

Surgical pulmonary embolectomy in a multi-trauma patient: One-center experience in the resource-limited setting.

Pulmonary embolism, a serious complication after trauma, may cause sudden death. We discuss an unusual case of 65-year-old woman who had traffic accident with liver injury and open fracture of both tibia and fibula on the right side. She was diagnosed with massive pulmonary embolism on the second day after accident and successfully underwent emergency surgical embolectomy from bilateral pulmonary arteries. There were no postoperative complications. The patient's good state of health was recorded after 13 months of surgery. Surgical pulmonary embolectomy for such a multi-trauma patient provides valuable experience not only for our institution but also for the countries having similar resource-limited conditions.