Surgical stabilization of rib fractures in older adults: a retrospective cohort study

The role of surgical stabilization of rib fractures (SSRF) in older adults remains uncertain, particularly regarding functional recovery and long-term pain. This study examined whether chronological age influences postoperative outcomes and evaluated the performance of injury-severity scoring systems in geriatric patients undergoing SSRF. This retrospective cohort included 524 adults who underwent SSRF between 2012 and 2023. Patients were stratified into non-geriatric (< 65 years, n = 331) and geriatric (≥ 65 years, n = 193) groups. Demographics, injury characteristics, perioperative outcomes, pain trajectories, and functional recovery were compared. Predictors of postoperative complications and chronic pain were assessed using univariate and multivariate logistic regression. Correlations between clinical outcomes and RibScore, AIS-Thorax, and BPC18 were analyzed using Spearman coefficients. Geriatric patients were more often injured by low-energy falls and had higher rates of pulmonary contusion (74.6% vs. 63.9%) yet demonstrated complication rates similar to younger adults (14.0% vs. 12.7%, p = 0.696). Pain trajectories were comparable across all follow-up intervals. Functional recovery was slower in older adults, who required an additional month to return to baseline activity (median 3 vs. 2 months, p < 0.001). The number of fractured ribs on the operated side independently predicted postoperative complications (OR 1.863, 95% CI 1.396-2.487, p < 0.001), whereas age was not an independent predictor. Longer time-to-surgery (OR 1.341, p = 0.001), longer hospitalization (OR 1.059, p = 0.044), and postoperative complications (OR 1.941, p = 0.036) independently predicted chronic pain. AIS-Thorax showed the strongest correlations with clinical outcomes, while all three scoring systems demonstrated weak associations with postoperative pain. In appropriately selected patients, SSRF provides comparable safety and pain recovery across age groups. Although functional recovery is slower in older adults, overall outcomes remain favorable. These findings support shifting from age-based to physiology-based decision-making for SSRF.