Comparative Efficacy of Thoracoscopic and Conventional Open Rib Fracture Fixation: A Propensity Score-Matched Analysis

Background 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. Methods 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 thoracoscopic 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 stays, chest tube duration, mechanical ventilation time, ICU stay, and postoperative complications. Results After propensity score matching, 33 matched pairs were identified between the MG and the CG. The MG had shorter hospital stays compared to 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 minutes, P = 0.019). For the HG and CG, 24 matched pairs were obtained. Patients in the HG also had shorter hospital stays (18.04 ± 11.96 vs. 26.67 ± 14.61 days, P = 0.030). Conclusions Thoracoscopic rib fracture fixation is associated with shorter hospital stays, faster recovery, and fewer complications compared to conventional surgery. The hybrid approach is associated with potentially superior clinical outcomes in the management of multi-site fractures, including shorter hospitalization and accelerated functional recovery.