Operative vs. Non-operative Treatment of Acute Unstable Chest Wall Injuries: A Multi Centred Randomized Controlled Trial

Description

In this presentation, Niloofer Dehghan discusses a randomized controlled trial designed to evaluate the effectiveness of surgical versus non-operative treatment for patients with flail chest injuries. The study, which spanned from 2011 to 2018, was conducted across 15 centers in Canada and the US, with Saint Michael's Hospital in Toronto as the lead site. The research team, which included a wide range of contributors, focused on defining outcomes such as ventilator-free days and overall mortality, given the complexity and multi-faceted nature of treating severe chest injuries.



The trial involved 207 patients, with 99 receiving non-operative treatment and 108 undergoing surgical fixation using plates and screws. One key finding highlighted was the primary outcome of ventilator-free days within the first 28 days, showing a trend towards improvement in those who underwent surgery, although it did not achieve statistical significance. Additionally, while surgical intervention showed no difference in the length of ICU or hospital stays for non-intubated patients, it significantly reduced mortality rates among those who were intubated at the time of randomization.



The study concluded that surgical fixation of flail chest injuries results in lower mortality and improved outcomes for intubated patients, but offers minimal benefit to patients who are not intubated upon enrollment. This work represents a significant contribution to understanding how different treatment modalities impact recovery and survival in patients with complex thoracic traumas.

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