Diagnostic, therapeutic, and surgical repair trends in slipping rib syndrome: a survey of surgeons in the United States.

Background: Diagnostic, therapeutic and surgical techniques for slipping rib syndrome (SRS) are evolving to improve clinical outcomes and recurrence. Our objective was to evaluate current practice patterns in SRS diagnosis and treatment among surgeons nationally. Methods: An electronic survey was nationally distributed to surgeons who were identified as slipped rib repair providers to assess trends in diagnosis and treatment. Descriptive analyses were performed. Results: Twenty-four surgeons responded to the survey (45.3%). Almost half identified as thoracic surgeons (47.6%, n=10); 23.8% identified as pediatric surgeons (n=5), 23.8% as trauma/acute care surgeons (n=5), and 4.8% as general surgeons (n=1). Patient history (54.2%, n=13) and physical exam (70.8%, n=17) were reported as most important diagnostic factors. Of surgeons who utilized preoperative and intraoperative pain regimens, rib blocks with lidocaine were the most common (92.9%, n=13). Suturing of ribs/cartilage was identified as the most integral step in the slipped rib repair operation (70.8%, n=17), followed by excision of rib cartilage (66.7%, n=16), use of a biodegradable plate (54.2%, n=13) and utilizing excised rib cartilage as a spacer (29.2%, n=7). Trauma or inciting event was reported as a positive prognostic factor for post-operative pain relief (82.6%, n=19). Connective tissue disorder (58.3%, n=14) and hypermobility disorder (45.8%, n=11) were identified as the two most common factors associated with recurrence. Conclusions: This national survey of surgeons demonstrates high variability in management and expected outcomes related to diagnosis and treatment for SRS. Further research is needed to identify optimal patient selection and operative approach and long-term clinical outcomes.