Comparative Analysis of Surgical Stabilization of Traumatic Rib Fractures in Patients With Morbid Obesity: A Retrospective Review of the Nationwide Readmissions Database

Background The effectiveness of surgical stabilization of rib fractures (SSRF) in patients with obesity is unknown. Methods The Nationwide Readmissions Database 2015-2019 was used to identify adult patients with obesity and rib fractures (RF). The outcomes of those with Obesity who underwent SSRF were compared to non-operative management (NOM) and also to non-obese participants who underwent SSRF. Patient demographics and outcomes were characterized with univariate, multivariate, and inverse-propensity score (IWPS) analyses adjusting for confounding variables and selection bias. Primary outcomes included 30-day readmission, hospital length of stay (LOS), and mortality. Results 39 177 patients were included Obese with NOM 86% (n = 33,516), Obese SSRF 1.8% (n = 707), and non-Obese SSRF 13% (n = 4954). While comparing between Obese NOM vs Obese with SSRF, no significant differences in all-cause 30-day-readmission rates between groups were identified through multivariate analysis (odds ratio (OR) 1.16, 95% confidence interval (CI) 0.91-1.48), or IWPS analysis (OR 0.81, CI 0.50-1.31). Patients undergoing SSRF vs NOM had increased median (IQR) LOS (12 (8-20) vs 6 (3-12) days, P < 0.001), but lower rates of in-hospital mortality (1.7% vs 6.2%, P < 0.001; OR 0.16, CI 0.09-0.28). While comparing SSRF in Obese vs non-Obese using a multivariate analysis, obesity did not confer greater odds of readmission (OR = 1.17, 95% CI 0.92-1.5) or death (OR = 0.74, 95% CI 0.4-1.35), and obesity did not contribute to a clinically significant increase in LOS (43 additional minutes, P < 0.05). Discussion In patients with obesity and rib fractures, SSRF is a valuable treatment option given its association with decreased rates of in-hospital mortality and comparable outcomes to their non-obese counterparts. Level of Evidence III. Study type therapeutic/Care management.