Early complications after surgical stabilization of rib fractures: A retrospective cohort study.

Background

In recent years, interest in SSRF has increased due to the growing evidence of improved pain control, quality of life, and chest wall function. This study aimed to assess the incidence and the types of early complications (in-hospital and until 3 mo postoperatively) following SSRF and to develop a risk prediction score based on potential risk factors for complications.

Methods

We conducted a retrospective single-center analysis including 554 patients who underwent SSRF between 2008 and 2023. Data were extracted from electronic medical records and included demographic, trauma-related, and surgical variables, as well as characteristics of complications. Logistic regressions and risk prediction analyses were performed for in-hospital complications.

Results

The main indication for SSRF was a displaced, painful series of fractures (76%). Complications occurred in 33% of patients during hospitalization and in 9% between discharge and three months postoperatively. In-hospital complications were predominantly grade Clavien-Dindo I (12%) and II (22%), whereas the most frequent grades within the postdischarge complications were I and IIIB (both 3%). Both in-hospital and postdischarge complications were mainly pulmonary and thoracic (18% and 5%) in origin. In univariate analysis, age, ASA, number of fractured and fixed ribs, flail chest, and Charlson Comorbidity Index were independent risk factors for any complication. In multivariate analysis, ASA and flail chest were the only independent factors. A risk prediction model showed a complication risk of 18% in patients with no flail chest, ASA ≤II, and age <75 years, compared with 65% in patients with flail chest, ASA ≥IV and age ≥75.

Conclusions

Early complications following SSRF are not rare but mostly minor. However, careful operation indication and perioperative management are particularly important in older, frail patients to avoid or reduce the risk of high-grade complications. LEVEL OF EVIDENCE Therapeutic, Care Management; Level III.