Título

OPERATIVE VS NONOPERATIVE TREATMENT OF ACUTE UNSTABLE CHEST WALL INJURIES: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objetivo

There is conflicting evidence between surgical and non-surgical treatment regarding acute unstable chest wall injury. Previous meta-analyses of only randomized controlled trials (RCT) included data only up to 2013. We aimed to perform an updated meta-analysis, including the most recent RCTs published, comparing outcomes in patients undergoing surgical or non-surgical treatment.

Método

We systematically searched Embase, PubMed, and Cochrane databases for RCT comparing surgical to non-surgical treatment in patients with acute unstable chest wall injuries. Endpoints were mechanical ventilation days (MVDs); mortality; length of hospital stay; length of intensive care unit (ICU) stay; incidence of pneumonia, and need for tracheostomy. Subgroup analysis was performed for patients who were already in mechanical ventilation at the time of randomization. Heterogeneity was examined with I² statistics. Quality assessment was performed with the Cochrane Collaboration Risk of Bias Assessment Tool, Cochrane Handbook for Systematic Reviews of Interventions was used for data manipulation and conversion. Review Manager 5.4 was chosen for statistical analysis.

Resultados

Our study includes a total of six RCTs, including 544 patients, from whom 269 (49.4%) patients had the surgical treatment performed. When compared to the nonoperative, the operative approach reduced the MVDs (WMD -5.25, 95% CI -5.66,-4.84; p < 0.001); time of hospital stay (WMD -6.44, 95% CI -12.17,-0.71; p = 0.03); length of ICU stay (WMD -4.80, 95% CI -6.57,-2.62; p < 0.001) and incidence of pneumonia (OR 0.26, 95% CI 0.10, 0.70; p = 0.007). There was no significant difference in mortality and need for tracheostomy between groups. In the subgroup analysis, the length of ICU stay (WMD -5.23, 95% CI -9.87,-0.59; p = 0.03) and length of hospital stay (WMD -4.98, 95% CI -7.26,-2.70; p < 0.001) also favors the surgical group.

Conclusões

Our results suggest that the operative approach in patients with acute unstable chest wall injuries is associated with fewer MVDs, shorter length of ICU stay, and time of hospital stay compared to the nonoperative approach. Similar results were shown in the subgroup analysis. However, further RCTs are needed because of the limited sample size.