Thoracoscopic rib fracture fixation versus conventional open rib fracture fixation: a comparative analysis of efficacy based on propensity score matching

With advances in minimally invasive techniques, complete video-assisted thoracoscopic surgery for rib fixation has demonstrated promising benefits. However, its efficacy relative to conventional open surgery remains controversial. This study aimed to compare clinical outcomes between thoracoscopic and conventional open surgery in patients with multiple rib fractures. A total of 141 patients between January 2016 and January 2025 were retrospectively analyzed. Based on the surgical approach, patients were categorized into a minimally invasive cohort (MG)—including the thoracoscopic fixation group (TG) and hybrid fixation group (HG) —and conventional surgery group (CG). Propensity score matching was performed to create balanced cohorts for comparing perioperative outcomes, including hospital stay, chest tube duration, mechanical ventilation duration, ICU stay, and postoperative complications. After propensity score matching, 33 matched pairs were identified between the MG and the CG. The MG had shorter hospital stay compared with the CG (18.42 ± 11.19 vs. 25.36 ± 15.46 days, P = 0.041), despite longer operative times (284.73 ± 123.83 vs. 214.70 ± 111.56 min, P = 0.019). For the HG and CG, 24 matched pairs were obtained. Patients in the HG also had shorter hospital stay (18.04 ± 11.96 vs. 26.67 ± 14.61 days, P = 0.030). The TG showed a trend toward shorter mechanical ventilation duration compared with the HG, but the difference did not reach statistical significance. The Thoracic Trauma Severity (TTS) score was identified as an independent risk factor for postoperative pulmonary infiltrative abnormalities during hospitalization (OR = 1.39; CI: 1.22–1.60; P < 0.001). Minimally invasive rib fracture fixation strategies (including complete thoracoscopic and hybrid approaches) are associated with shorter hospital stay compared with conventional open fixation. The hybrid approach achieves favorable clinical outcomes in patients with multi-site fractures, including shortened hospitalization. The TTS score was identified as a significant predictor of postoperative pulmonary infiltrative abnormalities, underscoring the importance of enhanced postoperative monitoring and targeted interventions in high-risk patients.