SSRF efficacy studied in new research paper
Recent research from David Meyer, MD, assistant professor in the Department of Surgery, has been published in the Annals of Surgery, studying the effectiveness of surgical stabilization of rib fractures (SSRF).
Patients suffering from rib fractures, which tend to be particularly painful and present a higher risk of secondary issues such as pneumonia and longer hospital stays, were randomized to two separate treatments. The first group received usual care, which includes pain management and breathing exercises to keep the lungs expanded, while the second underwent usual care plus surgery using a technique similar to that used by orthopedic surgeons to plate the broken ribs and stabilize them.
“The project was triggered by a desire to find a better way than usual care to help patients with broken ribs and to resume their normal activities earlier,” the researchers said. “Data leading to the research included existing evidence from randomized trials which suggested a benefit to surgery, but in a narrower patient population.”
Meyer was able to complete the research despite facing challenges in enrolling patients due to the ongoing COVID-19 pandemic. Not only were investigators tasked with deciding whether to enroll patients in the trial who were also COVID patients, but also the resulting pause in clinical research activities in order to conserve resources better allocated for fighting the pandemic.
Results of the trial showed that patients who underwent surgery did not experience better outcomes in any measured metrics. Additionally, patients who underwent surgery showed worse quality of life at one month in two key measure metrics, though the results were similar in other metrics, and after six months following injury, the quality of life between the two groups measured similarly. However, the authors said that due to the mix of patterns of broken ribs, benefits from surgery cannot be ruled out for all patients.
“Future research will focus on determining if there is still a subset of patients that may benefit, identifying if there are other treatments that may be more effective for controlling pain or getting patients back to their normal lives earlier that can be used with or in lieu of surgery, and continuing to improve on our non-operative adjuncts for treating these patients,” the researchers said.
Additionally, due to the small size of the trial, more studies will be needed to validate the findings of the research.
Meyer’s research for the trial was part of his final thesis for his recently completed master’s degree in clinical research. Meyer joined the Department of Surgery for fellowships in acute care surgery and surgical critical care in 2016 and began the Masters in Clinical Research program in 2019. This research was funded by a KL2 Award from the Center for Clinical and Translational Sciences (CCST) and additionally supported by the Center for Translational Injury Research (CeTIR).
Co-authors of the paper titled “Randomized Controlled Trial of Surgical Rib Fixation to Non-Operative Management in Severe Chest Wall Injury,” are John Harvin, MD; Laura Vincent, MS, RN; Kandice Motley; Michael Wandling, MD; Thaddeus Puzio, MD; Laura Moore, MD; Bryan Cotton, MD; Charles Wade, PhD; and Lillian Kao, MD. The authors would like to acknowledge Jon Tyson, MD, MPH, and the Center for Clinical Research and Evidence-Based Medicine for their mentorship and guidance on the trial.
The authors declare that there are no financial conflicts of interest in relation to the research.