{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:43:20Z","timestamp":1777934600832,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Surgical stabilization of rib fractures (SSRF) is associated with decreased mortality and respiratory complications. Patients who are not offered SSRF are often treated with epidural analgesia (EA) to reduce pain and improve pulmonary mechanics. We sought to compare infectious complications in patients undergoing either SSRF or EA. We hypothesized that infectious complications are equivalent between the two treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective cohort study of adult trauma patients with acute rib fractures within the Trauma Quality Improvement Program (TQIP) 2017 dataset and used\n                      <jats:italic toggle=\"yes\">International Classification of Diseases, Tenth Revision, Clinical Modification<\/jats:italic>\n                      (ICD-10-CM) codes to identify patients who underwent SSRF or EA. We excluded patients who received both treatments in the same admission. Our primary outcome was the development of sepsis. Secondary outcomes were specific infections including ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infections (CLABSI). Multiple logistic regression analyses were used to adjust for age, injury severity score (ISS), chest Abbreviated Injury Scale (AIS), flail chest, traumatic brain injury (TBI), and comorbidities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified 2,252 and 1,299 patients who underwent SSRF and EA, respectively. Patients with SSRF were younger with higher ISS and longer length of stay (LOS). There was no difference in mortality, however, SSRF had higher rate of sepsis (1.6% vs. 0.5%; p\u2009=\u20090.001), VAP (5.1% vs. 0.9%; p\u2009&lt;\u20090.001), CAUTI (1.7% vs. 0.5%; p\u2009=\u20090.001), and CLABSI (0.2% vs. 0%; p\u2009=\u20090.05). On multiple regression, SSRF was associated with higher odds of sepsis (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.04\u20136.63), CAUTI (OR, 2.96; 95% CI, 1.11\u20137.88), and VAP (OR, 3.24; 95% CI, 1.73\u20136.06). Among those who developed sepsis, there was no significant difference in mortality or LOS between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Despite no difference in mortality, SSRF was associated with increased risk of septic complications in patients with rib fractures compared to epidural analgesia. Identifying, and addressing, risk factors of sepsis in this patient population is a critical performance improvement process to optimize outcomes without increased adverse events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/sur.2022.002","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T10:18:31Z","timestamp":1656497911000},"page":"532-537","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures"],"prefix":"10.1177","volume":"23","author":[{"given":"Tareq","family":"Kheirbek","sequence":"first","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Cao","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia C.","family":"Tillman","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holden A.","family":"Spivak","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daithi S","family":"Heffernan","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie N.","family":"Lueckel","sequence":"additional","affiliation":[{"name":"Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,6,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199412000-00018"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.12.007"},{"key":"e_1_3_3_4_2","author":"Sweet AAR","unstructured":"Sweet AAR, , Beks RB FFA IJ, et al. Epidemiology of combined clavicle and rib fractures: A systematic review. Eur J Trauma Emerg Surg [Epub ahead of print; DOI: 10.1007\/s00068-021-01701-4].","journal-title":"Eur J Trauma Emerg Surg"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2019.04.020"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-010-0046-5"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.12.003"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-020-01526-7"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002559"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.08.011"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023444"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.10.010"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-018-0918-7"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.05.019"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-017-0877-4"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcr.2019.100247"},{"key":"e_1_3_3_17_2","first-page":"1750","article-title":"Pain as an indication for rib fixation: A bi-institutional pilot study","volume":"71","author":"de Moya M","year":"2011","unstructured":"de Moya M, , Bramos T, , Agarwal S, et al. Pain as an indication for rib fixation: A bi-institutional pilot study. J Trauma, 2011; 71:1750\u20131754.","journal-title":"J Trauma"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2005.111807"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.12.024"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-015-0091-5"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002103"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.06.002"},{"key":"e_1_3_3_23_2","author":"Fernandez CA","unstructured":"Fernandez CA, , Narveson JR, , Niu F, et al. In-hospital outcomes of intercostal nerve cryoablation and surgical stabilization of rib fractures. J Trauma Acute Care Surg [Epub ahead of print; DOI: 10.1097\/TA.0000000000003623].","journal-title":"J Trauma Acute Care Surg"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003391"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.02.009"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2016-000064"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003486"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-018-1020-x"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000925"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-016-0721-2"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/00031348211060432"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002994"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.02.057"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2013.06.023"},{"key":"e_1_3_3_35_2","first-page":"378","article-title":"What is new in the prevention of nosocomial pneumonia in the ICU?","volume":"23","author":"Klompas M","year":"2017","unstructured":"Klompas M. What is new in the prevention of nosocomial pneumonia in the ICU?. Curr Opin Crit Care, 2017; 23:378\u2013384.","journal-title":"Curr Opin Crit Care"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003262"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2021.165"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.06.054"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2022.025"}],"container-title":["Surgical Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/sur.2022.002","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/sur.2022.002","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/sur.2022.002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:28:27Z","timestamp":1777688907000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/sur.2022.002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,29]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,8,1]]}},"alternative-id":["10.1089\/sur.2022.002"],"URL":"https:\/\/doi.org\/10.1089\/sur.2022.002","relation":{},"ISSN":["1096-2964","1557-8674"],"issn-type":[{"value":"1096-2964","type":"print"},{"value":"1557-8674","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,29]]}}}