Surgical stabilization of rib fractures is associated with lower adjusted odds of adverse pulmonary outcomes across RibScore-defined injury severity: a single-center cohort study.

PURPOSE: Surgical stabilization of rib fractures (SSRF) is increasingly used for selected patients with severe chest wall injury, but its relationship with pulmonary outcomes after accounting for RibScore-defined injury severity remains unclear. This study evaluated adverse pulmonary outcomes after SSRF versus nonoperative management (NONOP) among adults with traumatic rib fractures. METHODS: Single-center retrospective cohort study at an ACS-verified Level I trauma center from January 2016 to April 2023. Adults with CT-confirmed blunt traumatic rib fractures were categorized as SSRF or nonoperative management. RibScore was calculated from initial CT imaging. The primary outcome was a composite of pneumonia, invasive mechanical ventilation for more than 48 h, or tracheostomy. Multivariable logistic regression adjusted for demographics, RibScore, thoracic and extra-thoracic injury severity, calendar year, COPD, and current smoking status. RESULTS: Among 3,066 patients, 444 underwent SSRF and 2,622 were managed nonoperatively. SSRF patients had greater radiographic chest wall injury severity, including a higher median RibScore than NONOP patients (2 vs. 0; p < 0.001). Composite adverse pulmonary outcome occurred in 14.6% of SSRF patients and 16.6% of NONOP patients. In adjusted analysis, SSRF was associated with lower odds of composite adverse pulmonary outcome (aOR 0.57, 95% CI 0.40-0.81; p = 0.002) and respiratory failure (aOR 0.57, 95% CI 0.39-0.83; p = 0.004). CONCLUSIONS: Despite greater radiographic chest wall injury severity, SSRF was associated with lower adjusted odds of composite adverse pulmonary outcome and respiratory failure compared with nonoperative management after accounting for RibScore and other injury severity measures.