MatrixRIB Caresynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...Rib Fixation Cost Savings...

$: MatrixRIB Caresynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...Rib Fixation Cost Savings MatrixRIB TM Care REFERENCES Please visit for more information. BACKGROUND Rib fractures$
Cost SavingsRib Fixation MatrixRIBTMCare

Helping you advance treatment of rib-fracture patients with a suite of tools and resources that help enable surgeons and hospitals to improve outcomes, increase patient satisfaction, and reduce costs:

• Case studies

• Care pathways

• Patient education materials

• MatrixRIBTM Fixation System

MatrixRIB™ Care

Instructions Page


REFERENCES Please visit www.matrixribcare.com for more information.

INSTRUCTIONS

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BACKGROUND Rib fractures are a common injury most commonly caused by blunt trauma to the chest as a result of motor vehicle accidents and falls.

• Rib fractures occur in ~10% of patients admitted to a trauma center and are a marker for severe injury1

• Patients with multiple rib fractures or a flail chest frequently require ventilation; mortality rates of up to 33% have been reported in flail chest1-4

• Prevalence of chronic pain of 22% and disability of 53% among patients with rib fractures5

• More than 30% of patients require additional care in postacute settings6

• Despite the clinical and economic impact of rib fractures, current treatment primarily consists of little more than supportive treatment including pain control, rest, and mechanical ventilation3,7,8 and the mortality and short-term morbidity have not improved appreciably during the last 4 decades3,9

• Availability of rib fixation technology presents a potential option toward an effective approach to managing rib fractures

http://www.matrixribcare.com



BACKGROUND Rib fractures are a common injury most commonly caused by blunt trauma to the chest as a result of motor vehicle accidents and falls.

• Rib fractures occur in ~10% of patients admitted to a trauma center and are a marker for severe injury1

• Patients with multiple rib fractures or a flail chest frequently require ventilation; mortality rates of up to 33% have been reported in flail chest1-4

• Prevalence of chronic pain of 22% and disability of 53% among patients with rib fractures5

• More than 30% of patients require additional care in postacute settings6

• Despite the clinical and economic impact of rib fractures, current treatment primarily consists of little more than supportive treatment including pain control, rest, and mechanical ventilation3,7,8 and the mortality and short-term morbidity have not improved appreciably during the last 4 decades3,9

• Availability of rib fixation technology presents a potential option toward an effective approach to managing rib fractures

XREFERENCES1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma.

1994;37:975-9.

2. Dehghan N, de Mestral C, McKee MD, Schemitsch EH. Nathens A. Flail chest injuries: A review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76:462-8.

3. Simon B, Ebert J, Bokhari F; Eastern Association for the Surgery of Trauma. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351-61.

4. Ciraulo DL, Elliott D, Mitchell KA ,Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg. 1994;178:466-70.

5. Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014;207:659-62; discussion 662-3.

6. Healthcare Cost and Utilization Project. 2012. Hospital discharges with International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) for flail chest (807.4) as a primary diagnosis.

7. Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215:201-5.

8. Nirula R, Allen B, Layman R, Falimirski ME, Somberg. Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006;72:307–9.

9. Allen GS and Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62:895-900.




CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATION Results from 2 recent meta-analyses, each including >500 flail chest patients, have shown that compared to medical management (nonoperative), surgical fixation patients had:1,2

• 57-69% less likely risk of mortality

• 55-82% less likely to have pneumonia

• 4.5-7.5 fewer days of mechanical ventilation

• 3.4-4.8 fewer ICU days

• 3.8-4.0 fewer hospital days




CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATION Results from 2 recent meta-analyses, each including >500 flail chest patients, have shown that compared to medical management (nonoperative), surgical fixation patients had:1,2

• 57-69% less likely risk of mortality

• 55-82% less likely to have pneumonia

• 4.5-7.5 fewer days of mechanical ventilation

• 3.4-4.8 fewer ICU days

• 3.8-4.0 fewer hospital days

REFERENCES1. Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib

fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258(6):914-21.

2. Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs non-operative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302-11.

X




CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATIONOperative Management is Associated with a Statistically Significant Lower Incidence of Mortality, Pneumonia, Tracheostomy, and Septicemia Compared to Non-Operative Management of Flail Chest1,2

*Septicemia not assessed.

Lower Odds of Mortality

Lower Odds of Pneumonia

Lower Odds of Tracheostomy

Lower Odds of Septicemia

69%

82%

88%

64%

OR 0.31; 95% CI: 0.20-0.48

OR 0.18; 95% CI: 0.11-0.32

OR 0.12; 95% CI: 0.04-0.32

OR 0.36; 95% CI: 0.19-0.71

Slobogean et al, 2013

Surgical Fixation Had:




57%

55%

75%

Pooled RR 0.43; 95% CI: 0.28-0.69

Pooled RR 0.45; 95% CI: 0.29-0.67

Pooled RR 0.25; 95% CI: 0.13-0.47

Leinicke et al, 2013

Surgical Fixation Had*:




*Septicemia not assessed.

CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATION




Lower Odds of Septicemia

69%

82%

88%

64%

OR 0.31; 95% CI: 0.20-0.48

OR 0.18; 95% CI: 0.11-0.32

OR 0.12; 95% CI: 0.04-0.32

OR 0.36; 95% CI: 0.19-0.71


Surgical Fixation Had:




57%

55%

75%

Pooled RR 0.43; 95% CI: 0.28-0.69

Pooled RR 0.45; 95% CI: 0.29-0.67

Pooled RR 0.25; 95% CI: 0.13-0.47


Surgical Fixation Had*:

Operative Management is Associated with a Statistically Significant Lower Incidence of Mortality, Pneumonia, Tracheostomy, and Septicemia Compared to Non-Operative Management of Flail Chest1,2

REFERENCES1. Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib fractures

in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258(6):914-21.

2. Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs non- operative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302-11.

X




-4.8-4.5


0

-1

-2

-3

-4

-5

-6

-7

-8

Decrease inVentilator Days

with Surgery

-3.4

Decrease inICU Days

with Surgery

-3.8

Decrease inHospital Dayswith Surgery

-7.5


0

-1

-2

-3

-4

-5

-6

-7

-8


with Surgery

Decrease inICU Days

with Surgery

-4.0


Ventilator Days 95% CI: –5.0 to –9.9ICU Days 95% CI: –1.6 to –7.9Hospital Days 95% CI: –0.7 to –7.4

Ventilator Days 95% CI: −5.54 to −3.50ICU Days 95% CI: −6.01 to −0.80Hospital Days 95% CI: −7.12 to −0.54

CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATIONSignificantly Fewer Number of Ventilator Days, ICU Days, and Hospital Days with Operative Management Compared to Non-Operative Rib Fixation of Flail Chest1,2




CLINICAL EVIDENCE SUPPORTING SURGICAL FIXATIONSignificantly Fewer Number of Ventilator Days, ICU Days, and Hospital Days with Operative Management Compared to Non-Operative Rib Fixation of Flail Chest1,2

-4.8-4.5


0

-1

-2

-3

-4

-5

-6

-7

-8


with Surgery

-3.4

Decrease inICU Days

with Surgery

-3.8


-7.5


0

-1

-2

-3

-4

-5

-6

-7

-8


with Surgery

Decrease inICU Days

with Surgery

-4.0


Ventilator Days 95% CI: –5.0 to –9.9ICU Days 95% CI: –1.6 to –7.9Hospital Days 95% CI: –0.7 to –7.4

Ventilator Days 95% CI: −5.54 to −3.50ICU Days 95% CI: −6.01 to −0.80Hospital Days 95% CI: −7.12 to −0.54

REFERENCES1. Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib fractures

in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258(6):914-21.

2. Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs non-operative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302-11.

X




STUDIES WITH MatrixRIB™ FIXATION SYSTEM Results from studies with MatrixRIB Fixation System demonstrated:

• MatrixRIB Fixation System patients (n=10) had a significant reduction in total ventilator days compared to the nonsurgical group (n=11, 4.5 vs 16.0; p=0.04)1

• 84% of patients (n=50) had no pain at 16 ± 1 month and patients who no longer had pain said their rib pain was completely gone at 5.4 ± 1.1 weeks post discharge2

• The need for analgesia was significantly reduced after MatrixRIB fixation in patients (n=16) with multiple rib fractures3

• Within 3 months MatrixRIB Fixation System patients (n=16) regained 84% Forced Vital Capacity (%FVC) and 77% Forced Expiratory Volume (FEV1)

4

• At 6 months, 7 of 15 patients that completed follow-up had returned to work4

• In a 16-month survey, of patients who were employed, 33 of 36 (92%) patients returned to work at the same job that they did preinjury2




STUDIES WITH MatrixRIB™ FIXATION SYSTEM Results from studies with MatrixRIB Fixation System demonstrated:

• MatrixRIB Fixation System patients (n=10) had a significant reduction in total ventilator days compared to the nonsurgical group (n=11, 4.5 vs 16.0; p=0.04)1

• 84% of patients (n=50) had no pain at 16 ± 1 month and patients who no longer had pain said their rib pain was completely gone at 5.4 ± 1.1 weeks post discharge2

• The need for analgesia was significantly reduced after MatrixRIB fixation in patients (n=16) with multiple rib fractures3

• Within 3 months MatrixRIB Fixation System patients (n=16) regained 84% Forced Vital Capacity (%FVC) and 77% Forced Expiratory Volume (FEV1)

4

• At 6 months, 7 of 15 patients that completed follow-up had returned to work4

• In a 16-month survey, of patients who were employed, 33 of 36 (92%) patients returned to work at the same job that they did preinjury2

REFERENCES1. Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity

improves liberation from mechanical ventilation. J Crit Care. 2014;29(1):139-43.

2. Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg. 2014;208:88-92.

3. de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma. 2011;71:1750–4.

4. Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44(2):232-8.

X




PATIENT-CENTERED OUTCOMES

Patient Satisfaction1

9.2 on a scale of 1-10 is what patients rated

their experience and the results of the procedure (1= not satisfied at all,

10 = very satisfied)

94% would recommend the surgery to injured

friends/family

7 is the median Quality of Life and

general health score according to the QLQ-C30

Quality of Life2

6 months post surgery 46% of

patients returned to work



7.9 weeks is the mean time back

to full-time work

Return to Work1,3

Click here for more detailed information.










friends/family



Quality of Life2






to full-time work

Return to Work1,3


Patient SatisfactionMajercik et al measured satisfaction with MatrixRib Fixation System on a scale of 1 to 10, with 1 being not satisfied at all, and 10 being very satisfied, patients (n=50) rated their experience with MatrixRIB Fixation System and the results of the procedure as 9.2 ± 0.2.1 Ninety-four percent stated that they would recommend the surgery to injured friends/family.1

Quality of lifeIn patients who underwent surgery using the MatrixRIB Fixation System, Billè et al found the median Quality of Life and general health score (n=6) according to the QLQ-C30 were 7 (range 6-7).2

Return to WorkReturn to work was evaluated in two studies with MatrixRIB Fixation System.1,3 Bottlang et al showed that at 6 months, 7 of 15 patients that completed follow-up had returned to work.3 In a 16-month survey, Majercik et al found that of the patients who were employed, 33 of 36 (92%) patients returned to work at the same job that they did preinjury. Mean time to get back to full-time work was 7.9 ± 1.0 weeks.1

X










friends/family



Quality of Life2






to full-time work

Return to Work1,3


REFERENCES1. Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes

after surgical stabilization of rib fractures. Am J Surg. 2014;208:88-92.

2. Billè A, Okiror L, Campbell A, Simons J, Routledge T. Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma. Gen Thorac Cardiovasc Surg. 2013;61(6):345-9.

3. Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44(2):232-8.

X




HOSPITAL ECONOMICS Based on the results from 2 recent published meta-analyses,1,2 for every 25 flail chest patients treated with rib fixation:

• Hospital costs could potentially be reduced by approximately $453,375-$792,786

• These savings may be due to reductions in ICU days, mechanical ventilation days, and incidence of pneumonia




HOSPITAL ECONOMICS Based on the results from 2 recent published meta-analyses,1,2 for every 25 flail chest patients treated with rib fixation:

• Hospital costs could potentially be reduced by approximately $453,375-$792,786

• These savings may be due to reductions in ICU days, mechanical ventilation days, and incidence of pneumonia

REFERENCES1. Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the

benefit? J Am Coll Surg. 2012;215(2):201-5.

2. Borrelly J, Aazami MH. New insights into the pathophysiology of flail segment: the implications of anterior serratus muscle in parietal failure. Eur J Cardiothorac Surg. 2005;28(5):742-9.

X




COST SAVINGSPotential Cost-savings per 25 Flail Chest Patients Undergoing Rib Fixation Surgery

ICU Cost $(292,500) $(413,011)

non-ICU Cost $(13,982) $27,964

MV Cost $(394,055) $(656,758)

Pneumonia Cost $(73,864) $(72,056)

Cost of Surgery $106,875 $106,875

Cost of Device $214,200 $214,200

$(453,375)Overall Cost Savings


$(792,786)Overall Cost Savings





MatrixRIB™ FIXATION SYSTEMThe MatrixRIB Fixation System is indicated for the fixation and stabilization of rib fractures, fusions, and osteotomies of normal and osteoporotic bone.




MatrixRIB™ FIXATION SYSTEM The MatrixRIB Fixation System is comprised of:

• Precontoured titanium alloy locking low-profile 1.5 mm thick plates with 2.9 mm diameter locking screws

• The plates are pre-contoured to fit the average rib shape, minimizing intraoperative bending

• Plate stiffness of MatrixRIB Fixation System is similar to cadaveric osteoporotic rib, allowing for flexibility of the rib cage

• The precontoured plates are long enough to fixate multiple and comminuted/ oblique fractures

• Anterior plating technique designed to avoid surgical disruption of intercostal soft tissues, and intramedullary splints allow minimally invasive procedures

• Instruments that enable rib stabilization of sub-scapular fractures




EXPERT POINT OF VIEW

Discussion of “how do you manage rib fracture(s)” is much more important than “who is an operative candidate” and in my mind a true rib program is what’s needed.

– Dr. Doben

More from our surgeon experts

It just makes sense that rib fractures be treated just like any other broken bone.

– Dr. Shiroff


http://www.depuysynthes.com/providers/improving-performance/matrixrib-care-program/case-studies



MatrixRIB™ CARE PROGRAM MatrixRIB Care Educational Tool Suite:

• Value Analysis Briefs

• Surgeon Consensus White Paper

• Surgeon Testimonials

• Case Studies

• Protocols

• Provider Education (ppt slides)

MatrixRIB Fixation System Training:

• Surgeon Training and Certification

- DePuy Synthes Institute Thoracic Trauma Courses

• Hospital and Operating Room Personnel Training

- Contact your local DePuy Synthes Companies Sales Consultant or call 800-523-0322




RESOURCESAhmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110:1676-80.

Allen GS and Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62:895-900.

Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215:201-5.

Billè A, Okiror L, Campbell A, Simons J, Routledge T. Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma. Gen Thorac Cardiovasc Surg. 2013;61:345-9.

Borrelly J, Aazami MH. New insights into the pathophysiology of flail segment: the implications of anterior serratus muscle in parietal failure. Eur J Cardiothorac Surg. 2005;28:742-9.

Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44:232-8.

Ciraulo DL, Elliott D, Mitchell KA ,Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg. 1994;178:466-70.

de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma. 2011;71:1750–4.

Dehghan N, de Mestral C, McKee MD, Schemitsch EH. Nathens A. Flail chest injuries: A review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76:462-8.

Doben AR, Eriksson EA, Denlinger CE, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care. 2014;29:139-43.

Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014;207:659-62; discussion 662-3.

Healthcare Cost and Utilization Project. 2012. Hospital discharges with International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) for flail chest (807.4) as a primary diagnosis.

Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258:914-21.

Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg. 2014;208:88-92.

Nirula R, Allen B, Layman R, Falimirski ME, Somberg. Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006; 72:307–9.

Simon B, Ebert J, Bokhari F, Capella J, et al; Eastern Association for the Surgery of Trauma. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351-61.

Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs non-operative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216:302-11.

Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975-9.

© DePuy Synthes 2015. All rights reserved. DSUS/CMF/0115/0280(1) 04/15


MatrixRIB Caresynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...Rib Fixation Cost Savings...

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