Chest wall reconstruction reduces hospital mortality following major chest wall trauma: a retrospective cohort study

Abstract

Introduction Chest wall reconstruction was introduced for the management of patients with severe chest wall injuries. We undertook a retrospective cohort study to investigate whether the treatment was associated with improved survival compared with conservative treatment. Methods A retrospective single institutional cohort study compared mortality following treatment of major chest wall trauma (Abbreviated Injury Scale ≥3) by chest wall reconstruction (CWR) to conservative management (Non-CWR) between September 2014 and December 2019. Univariable and multivariable associations between demographic and comorbid characteristics and mortality were estimated using Cox proportional hazard analysis and expressed as hazard ratios (HR) and corresponding confidence intervals (CI). Results Of a cohort of 947, CWR (n=157, 16.6%) had a lower prevalence of polytrauma (35.7 vs 56.3%, p<0.001) and head injury (11.5% vs 26.7%, p<0.001). CWR-treated patients experienced a greater number of fractured ribs, (8.3 vs 5.8, p<0.001), higher incidence of flail chest (84.9% vs 48.9%, p<0.001), higher admission to Critical Care (64.3% vs 44.1%, p<0.001), greater demand for ventilation (36.9% vs 25.6%, p=0.004) and a higher New Injury Severity Scale value (36.9 vs 34.6, p=0.003). Mortality of CWR patients was significantly lower (3.8% vs 8.6%, p=0.04), with adjusted HR 0.30 (95% CI 0.12, 0.72, p=0.008). Conclusions Chest wall reconstructive surgery, provided as a part of multidisciplinary treatment strategy for major thoracic trauma, reduces risk of mortality. The results validate the UK Government strategy, designed to reduce mortality, by centralising management of serious trauma in Major Trauma Centres.