@article {Zhange000943, author = {Gary Zhang and Eric Shurtleff and Carolyne Falank and Daniel Cullinane and Damien Carter and Forest Sheppard}, title = {Thoracoscopic-assisted rib plating (TARP): initial single-center case series, including TARP in the super elderly, technical lessons learned, and proposed expanded indications}, volume = {7}, number = {1}, elocation-id = {e000943}, year = {2022}, doi = {10.1136/tsaco-2022-000943}, publisher = {BMJ Specialist Journals}, abstract = {Objectives The application of surgical stabilization of rib fractures (SSRF) remains inconsistent due to evolving indications and perceived associated morbidity. By implementing thoracoscopic-assisted rib plating (TARP), a minimally invasive SSRF approach, we expanded our SSRF application to patients who otherwise might not be offered fixation. This report presents our initial experience, including fixation in super elderly (aged >=85 years), and technical lessons learned.Methods This was a retrospective cohort study at a level 1 trauma center of admitted patients who underwent TARP between August 2019 and October 2020. Patient demographics, injury characteristics, surgical indications and outcomes are represented as mean{\textpm}SD, median or percentage.Results A total of 2134 patients with rib fractures were admitted. In this group, 39 SSRF procedures were performed, of which 54\% (n=21) were TARP. Average age was 68.5{\textpm}16 years. Patients had a median of 5 fractured ribs, with an average of 1 rib that was bicortically displaced, and 19\% presented with {\textquoteleft}clicking{\textquoteright} on inspiration. Patient outcomes were a mean hospital length of stay (LOS) of 11{\textpm}3.7 days, mean postoperative LOS of 8 days, and mean intensive care unit LOS of 6.6{\textpm}2.9 days. Five patients were >=85 years old with a mean age of 90.8{\textpm}4.7 years. They presented with an average of 4 rib fractures, of which an average of 2.4 ribs were plated. The procedure was well tolerated in this age group with a hospital LOS of 9.4{\textpm}2 days, and all five patients were discharged to a rehab facility with no in-hospital mortalities.Conclusion Our experience incorporating TARP at our institution demonstrated feasibility of the technique and application across a broad range of patients. This approach and its application warrants further evaluation and potentially expands the application of SSRF..}, URL = {http://tsaco.smart01.highwire.org/content/7/1/e000943}, eprint = {http://tsaco.smart01.highwire.org/content/7/1/e000943.full.pdf}, journal = {Trauma Surgery \& Acute Care Open} }