Surgical stabilisation of rib fractures in non-ventilated patients: a retrospective propensity-matched analysis using the data from the trauma registry of the German Trauma Society (TraumaRegister DGU).

Purpose: Severe thorax trauma including multiple rib fractures and flail chest deformity are leading causes of death in trauma patients. Increasing evidence supports the use of surgical stabilisation of rib fractures (SSRF) in these patients. However, there is currently a paucity of evidence for its use in non-ventilator-dependent patients.

Methods: A retrospective propensity-matched analysis of the data of the TraumaRegister DGU for non-ventilator-dependent patients with severe rib injury (abbreviated injury score ≥ 3) was performed. Subgroup analyses with respect to injury severity score, American society of anaesthesiologists physical status classification and age were performed. Furthermore, the effect of time to surgery was analysed.

Registration: TR-DGU project ID 2023-007; ClinicalTrials.gov protocol ID: NCT06464289.

Results: SSRF led to reduced mortality compared to conservative treatment (1.6% vs. 4.8%; p = 0.002) and in comparison to the mortality prognosis of the revised injury severity classification II (RISC II) of 5.2%. Interestingly, SSRF was associated with increased length of hospital and intensive care unit stay, higher rates of organ failure and secondary intubation. The patients with organ failure received SSRF later than those without organ failure.

Conclusion: Here we report on the largest currently published dataset of non-intubated patients receiving SSRF, which showed reduced mortality in the SSRF cohort. The data indicates that SSRF is a viable treatment option for non-intubated patients. The observed late surgical time points, which may be due to cross over after failed conservative treatment, might be the cause for the observed increased rate of organ failure.