Effects of early surgery (within 48 hours) vs. delayed surgery on the incidence of pulmonary complications in elderly patients with multiple rib fractures.

BACKGROUND: Elderly patients have poor physical tolerance and obvious post-traumatic stress responses, with relatively higher risks of surgery and anesthesia, and there remains some controversy over the selection of surgical timing. This study explores the effects of early surgery within 48 hours after injury vs. delayed surgery on the incidences of pulmonary infection and respiratory failure in elderly patients with severe multiple rib fractures, so as to provide a reference for individualized selection of surgical timing in clinical practice. METHODS: The single tertiary trauma center served as the site of this retrospective clinical analysis. Raw data of blunt rib fracture hospitalizations from 2013 to 2023 were sourced from the hospital's electronic medical database, and 960 trauma patients aged ≥60 years were preliminarily screened for eligibility. Patients were divided into an early surgery group (surgery performed within 48 hours after injury) and a delayed surgery group (surgery performed more than 48 hours after injury) according to the interval from injury to operation. After screening by study eligibility criteria and subsequent propensity score matching procedures, 210 patients remained for analysis, equally divided into an early intervention cohort and a delayed operation cohort (n=105 per group). The incidences of pulmonary infection and acute respiratory failure were compared between the two groups. Meanwhile, the length of intensive care unit (ICU) stay, duration of mechanical ventilation, total hospital stay, pain scores at admission and discharge, duration of analgesic administration, fracture healing time, nonunion rate of fractures, and mortality were observed. RESULTS: The early surgery group exhibited lower rates of pulmonary infection and respiratory failure compared to the delayed surgery group, with shorter ICU hospitalization duration, mechanical ventilation time, and total hospital stay. CONCLUSIONS: For elderly critically ill patients with multiple rib fractures and stable vital signs, early surgery within 48 hours after injury is recommended, which can effectively reduce the risk of severe pulmonary complications. For patients with multiple underlying diseases and unstable conditions, symptomatic supportive treatment can be administered first, and elective surgery can be performed after physical conditions improve to enhance treatment safety.