Early Complications After Surgical Stabilization of Rib Fracture – A Retrospective Cohort Study

Background In recent years, interest in the surgical stabilization of rib fracture (SSRF) has increased considerably due to growing evidence demonstrating lower rates of pneumonia, improved respiratory mechanics, and reduced mortality. However, substantial uncertainty persists regarding optimal patient selection for SSRF. Systematic documentation of complications following SSRF is essential for internal quality assurance in trauma centres. Furthermore, the development of a risk stratification score for patients undergoing SSRF could serve as a valuable clinical decision-making tool and may aid in patient selection. Aims To evaluate the incidence of in-hospital complications after SSRF and their classification according to Clavien-Dindo. Methods Retrospective single-center analysis of 579 patients who underwent SSRF between 2008 and 2023. Logistic regressions were conducted for subgroup analysis. Results During hospitalization, 275 complications occurred in 186 patients (32.2%), including 66% of grade I and II according to Clavien-Dindo. Most observed complications were pulmonal and thoracic (36%), followed by cardiac (13%), and general surgical (12%). Univariate analysis showed that age, ASA score, polytrauma, number of fractured and fixed ribs, flail chest, interval trauma-surgery, bilateral rib fractures and higher Charlson Comorbidity Index were independent predictors of any in-hospital complication. On multivariate analysis, ASA score and flail chest were identified as the only predictors associated with in-hospital complications. Risk prediction model showed that the overall risk of any in-hospital complication was 32% and decreased to 18% in patients < 75 years with low ASA score and no flail chest. However, among patients > 75 years with flail chest and higher ASA scores (IV to V), the risk increased to 67%. Conclusion SSRF can be safely performed in most patients; however, careful patient selection and perioperative management are required in older frail patients to prevent or reduce high-grade complications.