Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

Abstract Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates.

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Retrospective Review of the Impact of a Chronic Obstructive Pulmonary Disease (COPD) Comprehensive Case Program on Hospital Readmission Rates

CHEST Journal ◽

10.1378/chest.2278816 ◽

2015 ◽

Vol 148 (4) ◽

pp. 715A

Author(s):

Abdulmajeed Alshabanat ◽

Carmen Rampel ◽

Jane Burns ◽

Don Sin ◽

Jeremy Road ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Retrospective Review ◽

Hospital Readmission ◽

Chronic Obstructive ◽

Readmission Rates ◽

Obstructive Pulmonary Disease ◽

Hospital Readmission Rates ◽

The Impact

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Long-Term Morbidity, Vain, and Disability after Repair of Severe Chest Wall Injuries

The American Surgeon ◽

10.1177/000313480907500508 ◽

2009 ◽

Vol 75 (5) ◽

pp. 389-394 ◽

Cited By ~ 42

Author(s):

John C. Mayberry ◽

Andrew D. Kroeker ◽

L. Bruce Ham ◽

Richard J. Mullins ◽

Donald D. Trunkey

Keyword(s):

Health Status ◽

General Population ◽

Chest Wall ◽

Flail Chest ◽

Fracture Repair ◽

Mcgill Pain Questionnaire ◽

Intractable Pain ◽

Long Term Outcomes ◽

Chest Wall Injury

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients’ health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey. RAND-36 outcomes were compared with reference values from the Medical Outcomes Study and from the general population. Forty-six patients underwent acute chest wall repair between September 1996 and September 2005. Indications included flail chest with failure to wean from the ventilator (18 patients), acute, intractable pain associated with severely displaced rib fractures (15 patients), acute chest wall defect/deformity (5 patients), acute pulmonary herniation (3 patients), and thoracotomy for other traumatic indications (5 patients). Three patients had a concomitant sternal fracture repair. Fifteen patients with a current mean age of 60.6 years (range 30-91) responded to our surveys a mean of 48.5 ± 22.3 months (range 19-96) postinjury. Mean long-term MPQ Pain Rating Index was 6.7 ± 2.1. RAND-36 indices indicated equivalent or better health status compared with references with the exception of role limitations due to physical problems when compared with the general population. The operative repair of severe chest wall injuries is associated with low long-term morbidity and pain, as well as health status nearly equivalent to the general population. Both the MPQ and the RAND-36 surveys were useful tools for determining chest wall pain and disability outcomes.

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Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society

International Orthopaedics ◽

10.1007/s00264-017-3612-1 ◽

2017 ◽

Vol 42 (2) ◽

pp. 401-408 ◽

Cited By ~ 16

Author(s):

Fredric M. Pieracci ◽

Suresh Agarwal ◽

Andrew Doben ◽

Adam Shiroff ◽

Larwence Lottenberg ◽

...

Keyword(s):

Chest Wall ◽

Flail Chest ◽

Rib Fractures ◽

Chest Wall Injury ◽

Wall Injury

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Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

International Journal of Care Coordination ◽

10.1177/20534345211001615 ◽

2021 ◽

pp. 205343452110016

Author(s):

Daphne Chakurian ◽

Lori Popejoy

Keyword(s):

Care Coordination ◽

Hospital Readmission ◽

Transitional Care ◽

Care Quality ◽

Integrative Review ◽

Labor Costs ◽

Readmission Rates ◽

Hospital Readmission Rates ◽

Care Models ◽

The Impact

Introduction Care coordination reduces care fragmentation and costs while improving health care quality. Transitional care programs, guided by tested models are an important component of effective care coordination, and have been found to reduce adverse events and prevent hospital readmissions. Using the Care Coordination Atlas as a framework, this article reports an integrative review of two transitional care models including analysis of model components, implementation factors, and associated 30-day all-cause hospital readmission rates. Methods Integrative review methodology. PubMed and Scopus databases were searched from January 2015 to July 2020. Fourteen studies set in 18 skilled nursing facilities and 50 hospitals were selected for data extraction and analysis. Results The ReEngineered Discharge model had five components and the Better Outcomes by Optimizing Safe Transitions model had eight components in the nine Care Coordination Atlas domains. Communication dominated activities in both models while neither addressed accountability/responsibility. Implementation was influenced by leadership commitment to understanding complexity of the models, culture change, integration of models into workflows, and associated labor costs. Model implementation studies consistently reported improvements in facilities’ 30-day all-cause hospital readmission rates. Discussion The Care Coordination Atlas was a useful framework to guide analysis of transitional care models. Leadership commitment to and participation in model implementation is vital. The models do not focus beyond the immediate post-discharge period limiting the impact on chronic disease management. Frameworks such as the Care Coordination Atlas are useful to help guide development of care coordination activities and associations with readmission rates.

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