Patient centered outcomes after surgical stabilization of rib fractures: A prospective cohort study

Rib fractures are associated with pain, impaired physical function, and reduced quality of life. Surgical stabilization of rib fractures (SSRF) is established for flail chest and ventilator-dependent patients, but its impact on longer-term patient-reported outcomes in broader injury patterns remains unclear. We evaluated whether SSRF is associated with improved physical functioning and pain outcomes compared to nonoperative management.

We conducted a prospective observational cohort study of trauma ICU patients with rib fractures admitted between June 2023 and August 2024 at a single Level I trauma center. Patients met institutional criteria for SSRF, including flail chest, ≥ 3 contiguous rib fractures, or ventilator failure. Outcomes were assessed using the SF-36 and SF-MPQ-2 at discharge, 2 weeks, 3 months, and 6 months. Multivariable linear regression adjusted for RibScore, flail chest, ISS, age, obesity, hospital length of stay, and associated injuries. Primary outcomes were SF-36 physical functioning and SF-MPQ-2 present pain intensity (PPI).

Of 121 patients, 39 (32%) underwent SSRF. The SSRF group had greater chest injury severity, including higher RibScores and more pneumothorax and hemothorax, while overall injury severity and demographics were similar. There were no differences in ICU length of stay, hospital length of stay, ventilator days, or mortality. After adjustment, SSRF was associated with improved physical functioning at discharge (β 13.29, 95% CI 6.53-20.05; p < 0.001) and at 6 months (β 23.40, 95% CI 7.52-39.28; p = 0.005). SSRF was associated with lower pain at discharge, but not at 6 months.

SSRF was associated with improved short-term and six-month physical functioning without differences in inpatient outcomes or sustained differences in pain. These findings suggest SSRF may primarily accelerate functional recovery rather than provide durable pain reduction.

II Study type: Prospective Cohort.