Impact of obesity on outcomes of surgical stabilization of rib fractures

INTRODUCTION Blunt trauma patients (BTPs) frequently present with rib fractures. Surgical stabilization of rib fractures (SSRF) has shown to improve outcomes by reducing complications. Given the increasing prevalence of obesity, understanding its influence on surgical outcomes after SSRF is warranted. OBJECTIVE We aimed to evaluate the impact of obesity on SSRF outcomes in BTPs with rib fractures, hypothesizing that obese patients would have an increased associated risk of respiratory complications. METHODS Trauma Quality Improvement Program database (2017–2022) was queried for BTPs 18 years or older with multiple rib fractures and/or flail segment undergoing SSRF. Obese ((+)obese) patients were compared with nonobese ((−)obese) patients. The primary outcome was respiratory complications (unplanned reintubation, acute respiratory distress syndrome, and ventilator-associated pneumonia). Bivariate and multivariable analyses were performed. RESULTS From 18,952 BTPs with rib fractures who underwent SSRF, 7,176 (38%) were obese. Both groups had similar median Injury Severity Scores of 17; however, the (+)obese group had lower rates of lung injuries (89.5% vs. 92.4%, p < 0.001). (+)Obese patients had higher rates of overall respiratory complications (13.7% vs. 11.3%, p < 0.001), including acute respiratory distress syndrome (2.2% vs. 1.6%), unplanned reintubation (8.0% vs. 7.1%), and pulmonary embolism (2.1% vs. 1.4%) (all p < 0.05); however, both (+)obese and (−)obese cohorts had similar rates of mortality (2.8% vs. 2.4%, p = 0.173). On multivariable analysis, (+)obese patients had an increased associated risk of respiratory complications (odds ratio, 1.29; 95% confidence interval, 1.17–1.42; p < 0.001), but risk of mortality remained similar between cohorts (odds ratio, 1.17; 95% confidence interval, 0.96–1.42; p = 0.13). CONCLUSION In this study, 38% of patients undergoing SSRF were obese. Despite similar Injury Severity Scores, obese patients had lower rates of lung injuries but had an increased associated risk of respiratory complications. Adipose tissue may provide some external protection but is independently associated with increased postoperative respiratory challenges. Further research is needed to develop strategies that reduce complications and enhance recovery in this population. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.