Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study

Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization

La question de l'accessibilité dans les décisions des médecins régulateurs des centres 15

National audienc

L’aide à la décision dans la régulation médicale téléphonique: l'apport du géographe

International audienc

Les incidences du sentiment de culpabilité sur la demande d’aide de l’aidant familial

International audienc

Outcomes of pneumonectomy for N2 non small cell lung cancer

International audienc

:5; Personal non-commercial use only

ABSTRACT. Objective. To describe deaths for which ankylosing spondylitis (AS) was on death certificates in France. Methods. Death certificates in which AS was indicated were evaluated. Standard mortality ratio (SMR) was assessed. Results. AS appeared in 2940 death certificates. The mortality rate of AS seemed stable. The most frequent initial causes were diseases of the circulatory system [28.3% in the International Classification of Diseases, 10th ed (ICD-10)]. SMR adjusted for age and sex were 2.1 (95% CI 1.45-2.91) for infections and 0.43 (0.36-0.5) for cancers (ICD-10 period). Conclusion. This study found an increase in mortality from infectious and external causes of death; conversely, patients with AS appear to die less frequently from cancer. (First Release March 15 2017