Better late than never? Efficacy of late surgical stabilization of acute rib fractures as compared to nonoperative management.
TL;DR
Although early intervention remains ideal, late SSRF may provide clinical benefits in selected patients, and is associated with improved in-hospital outcomes.
Abstract
Background
Surgical stabilization of rib fractures (SSRF) for severe chest wall injury has increased, with research showing improved outcomes compared with nonoperative management. Ideally, SSRF is performed within 3 days of injury. We hypothesize that late SSRF (days 5 to 14 post-injury) provides benefit over nonoperative treatment in patients with severe chest trauma.
Methods
We analyzed a prospectively collected database (2016 to 2024) from an urban level I trauma center, including patients with ≥3 severely displaced rib fractures. Propensity score matching (PSM, 1:2) was used to compare patients undergoing late SSRF (days 5 to 14 post-injury) to those hospitalized ≥5 days who did not receive SSRF. Outcomes measured were daily morphine milligram equivalents (MME), epidural use, opioid prescription at discharge, hospital length of stay (LOS), ICU-free days, ventilator-free days (VFD), pneumonia, tracheostomy, and mortality.
Results
Among 364 SSRF patients, 28 (8%) underwent late SSRF; these patients were matched to 56 No-SSRF patients. Both groups had similar demographics. SSRF patients had lower injury severity score (ISS) (17 vs. 26) but higher RibScore (3.5 vs. 3.0). Late-SSRF patients had significantly lower maximum daily MME post-day 5 (60 mg vs. 148 mg, P=0.045) and nonsignificantly lower median MME (56 mg vs. 67 mg, P=0.47) than No-SSRF patients. There were nonsignificant differences in use of epidurals (8% vs. 33%, P=0.22) and discharge with opioids (75% vs. 87%, P=0.38). Late SSRF was associated with more ICU-free days (6.5 vs. 3.5, P=0.02), shorter hospital LOS (9.0 vs. 16.5 d, P=0.008), and reduced pneumonia incidence (0% vs. 33%, P=0.03). Nonsignificant differences in tracheostomies, VFD, and mortality between the study groups.
Conclusions
Late SSRF is associated with improved in-hospital outcomes. Although early intervention remains ideal, late SSRF may provide clinical benefits in selected patients. (J Trauma Acute Care Surg. 2026;00: 000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. LEVEL OF EVIDENCE Level III, retrospective review.