Real-world time-trend impact of rib fracture fixation on patients with multiple trauma using propensity score and ARIMA approaches

Thoracic injuries, especially rib fractures, carry high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) has emerged as a promising approach to reduce pulmonary complications. We aimed to analyze the benefits of SSRF beyond flail chest and make the study applicable to clinical practice. This study compared SSRF and conservative treatments at a tertiary trauma center. A time series analysis and propensity score matching were applied to evaluate the outcomes. Data from a trauma registry (January 2017 to December 2020) were used. Exclusion criteria included patients with non-salvageable injuries and those transferred after 72 h. Primary outcomes were ventilator-free days on day 28 (VFD28) and non-procedural pulmonary complications (NPRCs). Of 770 eligible patients, 692 were enrolled, with 164 undergoing SSRF. SSRF patients had significantly longer VFD28 (22.5 vs. 19.0; P = 0.042) and reduced NPRCs (8.0 % vs. 14.5 %; P = 0.086). Subgroup analysis showed that SSRF patients requiring mechanical ventilation had longer ICU-free days (IFD28) and hospital-free days (HFD90) and lower mortality rates. Those not receiving ventilation but with more than three rib fractures also benefited from SSRF in terms of reduced NPRCs. SSRF improved clinical outcomes in more than just flail chest cases, benefiting patients with multiple rib fractures, both with and without mechanical ventilation. These findings support the broader clinical application of SSRF.