The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of metal rib reinforcements to stabilise a flail chest wall.
The condition in which multiple rib fractures allow a segment of the rib cage to move independently from the main chest wall is called a flail chest. The effect compromises breathing and may be life-threatening.
In this procedure, metal (usually titanium) is used to stabilise the ‘flail’ segment of chest wall. This procedure aims to improve lung function and reduce the length of critical care and hospital stay.
The following OPCS-4 codes are available:
W19.8 Other specified primary open reduction of fracture of bone and intramedullary fixation
W19.9 Unspecified primary open reduction of fracture of bone and intramedullary fixation
W20.1 Primary open reduction of fracture of long bone and extramedullary fixation using plate NEC
W20.6 Wiring of sternum
W20.8 Other specified primary open reduction of fracture of bone and extramedullary fixation
W20.9 Unspecified primary open reduction of fracture of bone and extramedullary fixation
The following site codes can be added to identify which ribs are involved:
Z74.3 First rib
Z74.4 Second to tenth rib
Z74.5 Eleventh or twelfth rib
Z74.6 Rib NEC
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.