Surgical Rib Fixation Improves Survival in Functionally Dependent Trauma Patients

Background Rib fractures are frequently encountered in trauma care and are particularly hazardous for functionally dependent patients, leading to increased morbidity and mortality rates. Surgical rib fixation (SRF) improves outcomes in selected populations; however, its role in functionally dependent individuals remains underexplored. Methods A retrospective cohort analysis was conducted using the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) dataset from 2020 to 2022. Patients with three or more rib fractures and documented functional dependency were included. Propensity score matching (3:1) was applied to reduce the selection bias between patients receiving SRF and those managed conservatively. The main outcomes of interest were in-hospital mortality, acute respiratory distress syndrome (ARDS), unplanned intensive care unit (ICU) admission, unplanned intubation, and ventilator-associated pneumonia (VAP). A subgroup analysis compared early (≤ 72 hours) versus late SRF. Results Among 18,639 eligible patients, 359 (1.9%) underwent SRF. Before matching, patients with SRF had higher injury severity scores (ISS), ICU admissions, and complication rates. After matching (294 SRF vs. 883 conservative patients), SRF was associated with significantly lower mortality (4.8% vs. 9.4%, p  = 0.017) despite higher rates of ARDS (2.0% vs. 0.5%, p  = 0.019), unplanned ICU admission (11.2% vs. 6.3%, p  = 0.009), unplanned intubation (10.2% vs. 3.9%, p  < 0.001), and VAP (3.1% vs. 0.8%, p  = 0.007). In the subgroup analysis, early SRF led to fewer ventilator days ( p  = 0.013), and shorter ICU ( p  < 0.001), and hospital length of stays ( p  < 0.001), with no difference in mortality compared with late SRF. Conclusion SRF in functionally dependent patients with rib fractures significantly reduces in-hospital mortality, despite a higher incidence of complications and prolonged ICU length of stays. Early SRF further improves clinical outcomes by decreasing ventilator duration and overall hospital length of stay. These findings support the consideration of SRF—particularly when performed early—as a beneficial strategy for managing rib fractures in functionally dependent patients. Future prospective studies are warranted to validate these results and establish clear patient selection criteria.