Cost-benefit analysis of rib fixation for multiple rib fractures in US trauma patients

The surgical stabilization of rib fractures has seen increased adoption as indications expand beyond flail chest. However, little literature addresses the cost implications of this broader use. This study compares hospitalization costs and outcomes in US trauma patients undergoing rib fixation.

The Nationwide Readmissions Database (2016-2020) was queried for trauma patients with multiple rib fractures. Those undergoing rib fixation were identified and matched 1:1 to nonoperative patients using propensity scores based on injury severity, mechanism, flail chest, age, sex, length of stay, and 38 Elixhauser comorbidities. The primary outcome was hospital readmission within 1 year. Secondary outcomes included total cost (including readmissions), insurance status, median household income, and hospital ownership/control.

Among 201,718 patients with multiple rib fractures, 8,290 were included in the matched analysis (4,145 per group). The overall readmission rate was 11.8%, with rib fixation associated with reduced readmission risk (odds ratio, 0.76 [0.66-0.87]; p < 0.01). Rib fixation was linked to 44.1% higher index hospitalization costs ($59,317 vs. $41,165, p < 0.01) and 37.7% higher total costs including readmissions ($61,438 vs. $44,612, p < 0.01). Patients with private insurance were more likely to undergo fixation (odds ratio, 1.18 [1.08-1.28]; p < 0.01), while those from lower-income households or treated at public hospitals were less likely (odds ratio of 0.86 and 0.61, respectively; both p < 0.01).

Although rib fixation increases total hospitalization costs, the associated reduction in readmissions may partially offset these expenses. These findings support the expanded use of surgical stabilization of rib fractures but highlight disparities in access based on insurance and socioeconomic status. Future research should examine strategies to promote equitable access.

Therapeutic/Care Management; Level III.