Mortality and Morbidity in Rib Fracture Surgery: Pulmonary Contusion Versus Extrathoracic Trauma

Introduction

This study aimed to determine whether the primary cause of morbidity and mortality in patients undergoing rib stabilization surgery due to blunt trauma-induced rib fractures is pulmonary contusion or associated extrathoracic trauma.

Methods

Patients aged 18-80 y diagnosed with flail chest following blunt trauma and undergoing rib stabilization surgery between January 1, 2014, and January 1, 2024, were included. Collected data encompassed demographics, trauma type, associated injuries, surgery timing, mechanical ventilation, extubation time, intensive care unit stay, and morbidity/mortality outcomes. Statistical analyses were performed using Statistical Package for the Social Sciences 22.0, with a significance level of P < 0.05.

Results

Among 110 patients, the mean age was 55.6 ± 13.9 y, with 80.9% being male. Early stabilization (<72 h) was performed in 77.3%, and late stabilization (>72 h) in 22.7%. Prolonged intensive care unit stays (>2 d) were observed in 52.7%, with an average hospital stay of 14.63 ± 20.17 d. Pneumonia (31.8%) was the most common morbidity, and the mortality rate was 14.5%. Pulmonary contusion (P = 0.021) and vertebral injury (P = 0.007) were significantly associated with pneumonia. Abdominal trauma increased tracheostomy rates (P = 0.038), and maxillofacial trauma was associated with mortality (P = 0.030).

Conclusions

Timely rib stabilization and a multidisciplinary approach are critical for managing thoracic injuries. Trauma severity and associated injuries significantly influence outcomes. Standardized protocols for intervention timing and patient selection may help reduce morbidity and mortality in multitrauma patients.