Table 2. Overview of studies addressing timing to SSRF.
| Author (year) | Study period | Study design | Indication for SSRF | Time to SSRF | Sample size SSRF | Follow-up time | Major outcomes | Limitations |
|---|---|---|---|---|---|---|---|---|
| Althausen, et al. (2011) (78) | 01-2005 to 01-2010 | Single center retrospective cohort | Flail chest and pulmonary hernia | Mean 2.3 d (range, 1–5 d) | 22 | Mean, 17.8 (range, 13–22) months | Shorter time to SSRF was associated with shorter HLOS, ICU-LOS, and DMV | Retrospective, single center study, small sample size and no insight in reason for timing of SSRF |
| Iqbal, et al. (2018) (79) | 03-2015 to 05-2016 | Single center retrospective cohort | Flail chest and ≥3 displaced rib fractures | Early (≤48 h); late (>48 h) | Early (n=65); late (n=37) | 3 months | Early SSRF group had shorter HLOS, ICU-LOS, DMV, and lower rates of pneumonia and tracheostomy | Retrospective, single center study, short FU, and no insight in stratification reason in SSRF groups |
| Pieracci, et al. (2018) (75) | 01-2006 to 01-2017 | Multicenter retrospective cohort | Flail chest, ≥3 displaced rib fractures, ≥30% volume loss of hemithorax, failing nonoperative management | Early (≤24 h); mid (1–2 d); late (3–10 d) | Early (n=207); mid (n=168); late (n=176); | Not specified | Early SSRF group had shorter HLOS, ICU-LOS and DMV >24 h. Each additional day was associated with increase in pneumonia, tracheostomy, and DMV >24 h likelihood | Retrospective study with short FU and no insight in stratification reason in SSRF groups |
| Su, et al. (2019) (80) | Not specified | Single center retrospective cohort | Flail chest, ≥4 displaced rib fractures, respiratory failure, intractable pain after nonoperative management | Early (≤3 d); late (>3 d) | Early (n=16); late (n=17) | Not specified | Early SSRF had shorter HLOS, ICU-LOS, and DMV. Time to SSRF was positively associated with shorter HLOS, ICU-LOS, DMV, and costs | Retrospective, single center study, small sample size, short FU, and no insight in stratification reason in SSRF groups |
| Harrell, et al. (2020) (81) | 01-2007 to 01-2018 | Single center retrospective cohort | Flail chest, rib displacement, respiratory failure, pain, flail sternum, pulmonary hernia | Early (0–2 d); mid (3–4 d); later (5–6 d); latest (>6 d) | Early (n=8); mid (n=34); later (n=31); latest (n=22) | Not specified | Early SSRF had shorter HLOS. As compared to NOM, patients who underwent SSRF after 2 days had longer HLOS and ICU-LOS | Retrospective, single center study, small sample size, short FU, and no insight in stratification reason in SSRF groups |
| Otaka, et al. (2020) (82) | 07-2010 to 04-2018 | Retrospective national database study | Flail chest or multiple rib fractures requiring mechanical ventilation ≤1 day of admission | Early (≤3 d); mid (≤6 d); late (≤10 d) | Early (n=62); mid (n=113); late (n=162) | Not specified | As compared to NOM, early SSRF was associated with shorter HLOS and DMV. The mid and late SSRF groups had similar outcomes to patients who underwent NOM | Retrospective study, no details on chest wall injury severity, and no insight in stratification reason in SSRF groups |
| Otaka, et al. (2020) (83) | 07-2010 to 04-2018 | Retrospective national database study | Flail chest or multiple rib fractures requiring mechanical ventilation ≤1 day of admission | Early (≤6 d); late (>6 d) | Early (n=113); late (n=98) | Not specified | The early SSRF group had shorter HLOS, DMV, and lower total costs. These results were similar in a subgroup analysis of patients without a flail chest | Retrospective study, no details on chest wall injury severity, and no insight in stratification reason in SSRF groups |
| Chen Zhu, et al. (2020) (84) | 01-2016 to 01-2018 | Retrospective national database study | Flail chest or multiple rib fractures in patients ≥65 years | Early (≤3 d); late (>3 d) | Early (n=366); late (n=375) | Not specified | The early SSRF group had lower rates of tracheostomy and pneumonia as well as shorter HLOS, ICU-LOS, and DMV | Retrospective study, no details on chest wall injury severity, and no insight in stratification reason in SSRF groups |
| Pieracci, et al. (2021) (85) | 01-2015 to 04-2020 | Multicenter retrospective cohort | Flail chest, ≥3 ipsilateral displaced rib fractures | Early (<3 d); late (≥3 d) | Early (n=63); late (n=70) | Not specified | As compared to late SSRF or NOM, early SSRF was associated with lower mortality risk, but higher risk of pneumonia and ICU-LOS ≥3 d | Retrospective study with short FU and no insight in stratification reason in SSRF groups |
SSRF, surgical stabilization of rib fractures; HLOS, hospital length of stay; ICU-LOS, intensive care unit length of stay; DMV, duration of mechanical ventilation; FU, follow-up; NOM, nonoperative management; UK, United Kingdom; US, United States of America.