Evolving Outcomes After Rib Fractures in Geriatric Patients: Revisiting Historical Data in the Modern Era

Rib fractures in the elderly are associated with significant morbidity and each additional rib fracture has shown an increased risk of pneumonia and death. However, the most recent data fully evaluating this effect is outdated, using x-ray imaging from the 1980-1990s. Computed tomography imaging is now the gold standard in diagnosis and management has evolved. We hypothesized that mortality rates would be decreased from those historical reports and sought to evaluate the effect of each additional rib fracture on geriatric outcomes.

A 5-year retrospective review of the trauma registry was performed for all geriatric patients, ≥65 years old, admitted to our level one trauma center with rib fracture. Rib fracture descriptions were taken from initial computed tomography imaging. Outcomes were analyzed using simple linear and logistic regression.

Among the 709 patients included, there was an average of 4.2 rib fractures per patient. Three complications were found to be significantly associated with the number of rib fractures: deep vein thrombosis (odds ratio [OR] 1.180, P = 0.026), cerebrovascular accident (OR 1.359, P = 0.021), and respiratory failure (OR 1.161, P < 0.001). Overall, 67 patients (9%) died. Mortality for patients with ≤6 rib fractures was 7.0%, with no significant increase per each additional fracture (OR 0.889, P = 0.243). For patients with >6 rib fractures, mortality was 20.6% and increased significantly for each additional fracture (OR 1.160, P = 0.048). Increasing age in years was also significantly associated with higher mortality (OR 1.056, P < 0.001). Significantly increased mortality was also noted with bilateral fractures (OR 2.088, P = 0.004) and pulmonary contusions (OR 2.242, P < 0.001).

Outcomes after rib fractures have improved over the last 2-3 decades although it remains a significant challenge. The associated odds of respiratory failure were increased by 16.1% for every additional rib fracture. Associated odds of mortality after rib fracture in the elderly were increased by 5.6% for every additional year of age, 16.0% for every additional rib fracture greater than six, and doubled if bilateral or if pulmonary contusions were present.