{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T22:09:06Z","timestamp":1771625346610,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Obesity is associated with adverse outcomes after major operations. The role of operative rib fixation (RF) in obese patients with flail chest is not clear. The presence of other associated injuries may complicate the interpretation of outcomes. This study compared outcomes after RF to nonoperative management (NOM) in obese patients with isolated flail chest injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult obese patients (BMI\u2009&gt;\u200929.9) with flail chest were identified from the Trauma Quality Improvement Program (TQIP) database (2016\u20132018). Hospital transfers, death within 72 h, and extrathoracic injuries were excluded. RF patients were propensity score matched (1:2) to similar NOM patients. Multivariate regression identified independent factors predicting adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 367 patients with isolated flail chest who underwent RF were matched with 734\u00a0in the NOM group. After matching, the mortality rate was significantly lower in the RF group (1.4% vs. 3.7%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). RF had longer HLOS (15.7\u00a0days vs. 12.8\u00a0days; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) and ICU LOS (10.1\u00a0days vs. 8.6\u00a0days; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), shorter ventilator days (9.2\u00a0days vs. 11.5\u00a0days; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), and a higher rate of venous thromboembolism (7.1% vs. 3.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). On multivariate analysis, RF was associated with decreased mortality (OR 0.27; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Early RF (\u2264\u200972 h) was associated with shorter ICU stay and mechanical ventilation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RF for isolated flail chest in obese patients is associated with decreased mortality and fewer ventilator days. When performed early, fixation decreases the need for prolonged ventilator use and ICU stay. A more aggressive VTE prophylaxis should be considered in patients undergoing RF.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06748-x","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T21:23:01Z","timestamp":1663968181000},"page":"2890-2899","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study"],"prefix":"10.1002","volume":"46","author":[{"given":"Joshua","family":"Dilday","sequence":"first","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, LAC+USC Medical Center University of Southern California 2051, Marengo St, Inpatient Tower, C5L100 90033 Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih Ying","family":"Chien","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, LAC+USC Medical Center University of Southern California 2051, Marengo St, Inpatient Tower, C5L100 90033 Los Angeles CA USA"},{"name":"Department of General Surgery Chang Gung Memorial Hospital Keelung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, LAC+USC Medical Center University of Southern California 2051, Marengo St, Inpatient Tower, C5L100 90033 Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Emigh","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, LAC+USC Medical Center University of Southern California 2051, Marengo St, Inpatient Tower, C5L100 90033 Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth R.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care Grady Memorial Hospital Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demetrios","family":"Demetriades","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, LAC+USC Medical Center University of Southern California 2051, Marengo St, Inpatient Tower, C5L100 90033 Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000086"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010200006000\u201000007"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2010.09.029"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010018\u20104723\u20106"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2007.02.005"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001209"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.05.085"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.10.047"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.10.038"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182ab0d7c"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002666"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2020.10.022"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102016\u2010000059"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010020\u201001526\u20107"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.05.032"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.04.005"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.12.024"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002994"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010018\u20100961\u20104"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.01.016"},{"issue":"4","key":"e_1_2_7_22_1","first-page":"727","article-title":"Surgical stabilization of internal pneumatic stabilization? 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