506 Video-Assisted Thoracoscopic Surgery in Traumatic Rib Fractures in Comparison with Conventional Surgery: Systematic Review and Meta-Analysis

Abstract Aim This review aims to analyse the efficacy and safety of Video-assisted thoracoscopic surgery (VATS) in the management of traumatic rib fractures. Method A systematic review was performed in accordance with the PRISMA guidelines identifying literature regarding the use of VATS in rib fractures. The primary efficacy outcome included change in pain score. Safety outcomes included mortality, infection, and readmission. Meta-analysis was performed using the RevMan and R software. Results 11 studies were included, with a total of 866,044 patients, of which 1,510 underwent VATS and 12,555 underwent conventional surgery. Participants included were predominantly male (77.46%), and the mean age was 53.22 ± 10.61 years. Overall, a considerable decrease of 2.60 (95% CI [1.38 – 3.83]) points was noted in the pain score within the VATS group which was higher when compared to conventional surgery (SMD = -1.62, 95% CI [-2.25, -0.99], p<0.01). Similarly, the rates of surgical site infections (OR = 0.21, 95% CI [0.06 – 0.68], p<0.01) and pneumonia (OR = 0.15, 95% [0.03 – 0.84], p = 0.03) were lower in the VATS group. The rates of mortality within 30 days were only 2.09% (95% CI [1.43% - 3.04%]), and readmission rates were 3.48% (95% CI [0.65% - 16.59%]) in the VATS group. Conclusions The results of the study suggest that there is a significant improvement in the Quality-of-Life in terms of change in pain score and reduced rates of infection, that make VATS a suitable alternative to conventional surgery in the management of traumatic rib injuries. However, further studies exploring the long-term effects are warranted.