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Sex-Based Differences in Surgical Stabilization Outcomes for Rib Fractures in Blunt Trauma Patients.

Negaar Aryan¹, Sebastian Dominik Schubl¹, Jeffry Nahmias¹

¹University of California Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, CA, USA.

The American Surgeon

|December 18, 2025

Summary

Males undergo surgical stabilization of rib fractures (SSRF) more often and face higher risks of respiratory complications and mortality compared to females, despite similar injury severity. These outcomes highlight potential sex-based physiological differences in trauma recovery.

Keywords:

SSRF chest wall muscle mass respiratory complication sex-based differences surgical stabilization of rib fractures

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Area of Science:

Trauma surgery
Thoracic trauma
Surgical outcomes

Background:

Sex-based differences in rib fracture presentation and recovery can impact surgical stabilization of rib fractures (SSRF) outcomes.
Males' greater chest wall muscle mass may require higher-energy trauma, increasing risks of respiratory complications.

Purpose of the Study:

To compare SSRF rates in male and female blunt trauma patients (BTPs) with rib fractures.
To test the hypothesis that males undergo SSRF at a higher rate and experience more respiratory complications post-SSRF.

Main Methods:

Analysis of the Trauma Quality Improvement Program (TQIP) database (2017-2022) for adult BTPs with multiple rib fractures or flail segments.
Comparison of male and female SSRF BTPs.
Multivariable logistic regression to assess sex as a predictor of respiratory complications (unplanned intubation, ARDS, VAP).

Main Results:

SSRF rates were higher in males (3.1%) than females (2.3%).
Males had higher rates of severe thoracic injury, overall respiratory complications (13.0% vs 10.3%), ARDS, VAP, and unplanned intubation.
Multivariable analysis revealed males had increased odds of respiratory complications (OR 1.37) and mortality (OR 1.33).

Conclusions:

Males underwent SSRF more frequently and experienced increased risks of respiratory complications and mortality, even with comparable Injury Severity Scores (ISS).
Observed disparities suggest underlying anatomical or physiological factors contribute to sex-based differences in trauma outcomes.