Guideline-Driven Care Improves Outcomes in Patients with Traumatic Rib Fractures

2017 ◽  
Vol 83 (9) ◽  
pp. 1012-1017 ◽  
Author(s):  
Kathleen Flarity ◽  
Whitney C. Rhodes ◽  
Andrew J. Berson ◽  
Brian E. Leininger ◽  
Paul E. Reckard ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pulmonary Function ◽  
Hospital Length ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
National Standard ◽  
Separate Analysis ◽  
Fracture Management ◽  
Multivariable Regression

There is no established national standard for rib fracture management. A clinical practice guideline (CPG) for rib fractures, including monitoring of pulmonary function, early initiation of aggressive loco-regional analgesia, and early identification of deteriorating respiratory function, was implemented in 2013. The objective of the study was to evaluate the effect of the CPG on hospital length of stay. Hospital length of stay (LOS) was compared for adult patients admitted to the hospital with rib fracture(s) two years before and two years after CPG implementation. A separate analysis was done for the patients admitted to the intensive care unit (ICU). Over the 48-month study period, 571 patients met inclusion criteria for the study. Pre-CPG and CPG study groups were well matched with few differences. Multivariable regression did not demonstrate a difference in LOS (B = -0.838; P = 0.095) in the total study cohort. In the ICU cohort (n = 274), patients in the CPG group were older (57 vs 52 years; P = 0.023) and had more rib fractures (4 vs 3; P = 0.003). Multivariable regression identified a significant decrease in LOS for those patients admitted in the CPG period (B = -2.29; P = 0.019). Despite being significantly older with more rib fractures in the ICU cohort, patients admitted after implementation of the CPG had a significantly reduced LOS on multivariable analysis, reducing LOS by over two days. This structured intervention can limit narcotic usage, improve pulmonary function, and decrease LOS in the most injured patients with chest trauma.

Early Intravenous Ibuprofen Decreases Narcotic Requirement and Length of Stay after Traumatic Rib Fracture

2013 ◽  
Vol 79 (11) ◽  
pp. 1207-1212 ◽  
Author(s):  
Lilly Bayouth ◽  
Karen Safcsak ◽  
Michael L. Cheatham ◽  
Chadwick P. Smith ◽  
Kara L. Birrer ◽  
...  
Keyword(s):  
Treatment Group ◽  
Length Of Stay ◽  
Hospital Length ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
Patient Comfort ◽  
Clinically Significant ◽  
Control Pain ◽  
Intravenous Ibuprofen

Pain control after traumatic rib fracture is essential to avoid respiratory complications and prolonged hospitalization. Narcotics are commonly used, but adjunctive medications such as non-steroidal anti-inflammatory drugs may be beneficial. Twenty-one patients with traumatic rib fractures treated with both narcotics and intravenous ibuprofen (IVIb) (Treatment) were retrospectively compared with 21 age- and rib fracture-matched patients who received narcotics alone (Control). Pain medication requirements over the first 7 hospital days were evaluated. Mean daily IVIb dose was 2070 ± 880 mg. Daily intravenous morphine-equivalent requirement was 19 ± 16 vs 32 ± 24 mg ( P < 0.0001). Daily narcotic requirement was significantly decreased in the Treatment group on Days 3 through 7 ( P < 0.05). Total weekly narcotic requirement was significantly less among Treatment patients ( P = 0.004). Highest and lowest daily pain scores were lower in the Treatment group ( P < 0.05). Hospital length of stay was 4.4 ± 3.4 versus 5.4 ± 2.9 days ( P = 0.32). There were no significant complications associated with IVIb therapy. Early IVIb therapy in patients with traumatic rib fractures significantly decreases narcotic requirement and results in clinically significant decreases in hospital length of stay. IVIb therapy should be initiated in patients with traumatic rib fractures to improve patient comfort and reduce narcotic requirement.

Do Lidocaine Patches Reduce Opioid Use in Acute Rib Fractures?

2020 ◽  
Vol 86 (9) ◽  
pp. 1153-1158
Author(s):  
Matthew Johnson ◽  
Lauren Strait ◽  
Ashar Ata ◽  
Ashley Bartscherer ◽  
Claire Miller ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Opioid Use ◽  
Trauma Service ◽  
Fracture Management ◽  
Multimodal Care

Background Pain control is an important aspect of rib fracture management. With a rise in multimodal care approaches, we hypothesized that transdermal lidocaine patches reduce opioid utilization in hospitalized patients with acute rib fractures not requiring continuous opioid infusion. Methods We performed a retrospective analysis of adult trauma patients with acute rib fractures admitted to the Trauma Service from January 2011 to October 2018. We compared patients who received transdermal lidocaine patches to those who did not and evaluated cumulative opioid consumption, expressed in morphine milligram equivalents (MMEs). Secondary outcomes included the rate of pulmonary complications and length of hospital stay. Results Of the 21 190 trauma admissions, 3927 (18.5%) had rib fractures. Overall, 1555 patients who received continuous opioid infusion were excluded. Of the remaining 2372 patients, 725 (30.6%) patients received lidocaine patches. The mean total MME of patients who received lidocaine patches was 55.7 MME (30.7 MME on multivariate analysis) and was lower than that of patients who did not receive lidocaine patches ( P ≤ .01). There was no difference in hospital length of stay (no lidocaine patches vs received lidocaine patches: 6.2 days vs 6.5 days, P = .34) or pulmonary complications (1.7% vs 2.8%, P = .08). Discussion In admitted trauma patients with acute rib fractures not requiring continuous intravenous opiates, lidocaine patch use was associated with a significant decrease in opiate utilization during the patients’ hospital course.

840: METHOCARBAMOL DECREASES HOSPITAL LENGTH OF STAY IN TRAUMA PATIENTS WITH RIB FRACTURES

2016 ◽  
Vol 44 (12) ◽  
pp. 286-286
Author(s):  
Asad Patanwala ◽  
Ohoud Aljuhani ◽  
Brian Kopp ◽  
Brian Erstad
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Trauma Patients

scholarly journals Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty

2021 ◽  
Vol 2 (8) ◽  
pp. 679-684
Author(s):  
Shahriar Seddigh ◽  
Lynn Lethbridge ◽  
Patrick Theriault ◽  
Stan Matwin ◽  
Michael J. Dunbar
Keyword(s):  
Length Of Stay ◽  
Wait Time ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
National Standard ◽  
Wait Times ◽  
Primary Arthroplasty ◽  
Total Knee ◽  
Primary Total Knee

Aims In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression. Results A total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for THA was 267 days (1 to 2,015) with mean LoS of 4.0 days (1 to 143). There was a significant increase in mean LoS for TKA waiting longer than 180 days (2.5% (SE 1.1); p = 0.028). There was no significant association for THA. Age, sex, surgical year, admittance from home, rural residence, household income, hospital facility, the need for blood transfusion, and comorbidities were all found to influence LoS. Conclusion Surgical WT longer than 180 days resulted in increased acute LoS for primary TKA. Meeting a shorter WT target may be cost-saving in a social healthcare system by having shorter LoS. Cite this article: Bone Jt Open 2021;2(8):679–684.

Displacement Patterns of Blunt Rib Fractures and Their Relationship to Thoracic Coinjuries: Minimal Displacements Count

2016 ◽  
Vol 82 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Nikolay Bugaev ◽  
Janis L. Breeze ◽  
Majid Alhazmi ◽  
Hassan S. Anbari ◽  
Sandra S. Arabian ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Rib Fractures ◽  
Axial Displacement ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Displacement Patterns

Displacement patterns of rib fractures (RF) and their association with thoracic coinjuries and outcomes are unknown. This is a retrospective review of adult patients with blunt closed RF who underwent chest CT at a Level I trauma center (2007–2012). Displacement patterns of RF were compared among the three-dimensional planes using CT images. An analysis of receiver operating characteristic (ROC) curves was performed to identify displacements in each plane most strongly associated with chest coinjuries. Univariate analysis was used to find association of displaced RF with hospital course and outcome. There were 1127 RF (245 patients, most in ribs 3–9, 45 per cent displaced). Axial displacement was the most common, with odds ratios 7.20 and 2.13 compared with cranio-caudal, and impaction-separation (along rib axis) movement, respectively. Axial displacement thresholds performed well with hemothorax (2.8 mm, ROC = 0.74), pneumothorax (2.6 mm, ROC = 0.70), hemopneumothorax (3.1 mm, ROC = 0.77), flail chest (3.4 mm, ROC = 0.80), and chest tube placement (2.8 mm, ROC = 0.75). RF displacement was associated with increased days on mechanical ventilation and hospital length of stay. In conclusion, even minimal RF displacement is associated with increased risk of chest coinjuries and chest tube placement, and displacements correlated with increased days on mechanical ventilation and hospital length of stay. Future studies are required to investigate these associations, especially in relationship to the indications for rib plating.

The Effect of Abdominal Binders on Postoperative Pulmonary Function

2009 ◽  
Vol 75 (2) ◽  
pp. 169-171 ◽  
Author(s):  
Christopher M. Larson ◽  
Erick R. Ratzer ◽  
Deborah Davis-merritt ◽  
Jeffrey R. Clark
Keyword(s):  
Length Of Stay ◽  
Pulmonary Function ◽  
Pain Control ◽  
Vital Capacity ◽  
Pulmonary Function Tests ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Postoperative Pulmonary Function ◽  
Function Tests

Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications. There has been some question as to the compressive effect that an abdominal binder has on pulmonary function. We prospectively randomized 54 patients undergoing a midline laparotomy incision to two groups: a “binder” group and a “no binder” group. Preoperative pulmonary function tests (vital capacity and incentive spirometry) were measured. Postoperatively, pulmonary function tests, pulse oximetry, oxygen requirement, pulmonary and wound complications, pain control, time to ambulation, and hospital length of stay were examined. Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent, respectively, but this was not statistically significant. Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8, 3 vs 6, and 3 versus 7, respectively. Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group. Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days, respectively. We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function, but seemed to help with pain control.

RIB fracture triage pathway decreases ICU utilization, pulmonary complications and hospital length of stay

Injury ◽  
2020 ◽  
Author(s):  
C. Caleb Butts ◽  
Preston Miller ◽  
Andrew Nunn ◽  
Adam Nelson ◽  
Meagan Rosenberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Rib Fracture ◽  
Hospital Length Of Stay
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