Incidence of pulmonary complications in rib fracture patients after surgical stabilization of rib fractures compared to RibScore prognostication.

BACKGROUND

Surgical stabilization of rib fractures (SSRF) has been associated with improved pain scores, fewer ventilator days, lower rates of ventilator-associated pneumonia and tracheostomy, shorter hospitalization, and reduced mortality. RibScore is a 6-point scoring system using chest wall injury radiographic data to predict adverse pulmonary outcomes (APOs). This study examines the incidence of APOs using RibScore criteria, hypothesizing the incidence of APOs decreases after SSRF.

METHODS

A single-institution retrospective review was performed for adult SSRF patients at a Level I trauma center between 1/2017 and 4/2023. Basic demographics were obtained. CT imaging was reviewed, and each patient was given a score based on RibScore criteria. Our primary outcome was incidence of adverse pulmonary outcomes (pneumonia, respiratory failure, need for tracheostomy) stratified by RibScore. The Mantel-Haenszel test for trend was used to create a linear trend between RibScore and APOs for patients who underwent SSRF. Rates of APOs after SSRF were compared to the original APOs for each RibScore.

RESULTS

A total of 452 patients were included in the study. There was an increase in rate of tracheostomy with increasing RibScore, which was statistically significant on linear-by-linear association (p = 0.003). Similar results were demonstrated for rate of pneumonia (p < 0.001) as well as rate of respiratory failure (p < 0.001). When comparing our SSRF patients to the original RibScore adverse pulmonary outcomes, there was a significant decrease in incidence of tracheostomy (p = 0.003), pneumonia (p < 0.001), and respiratory failure (p < 0.001).

CONCLUSION

In this cohort, SSRF was associated with lower adverse pulmonary outcome rates across RibScore strata within our center. RibScore supports risk stratification and shared decision making. Historical comparisons are descriptive and cannot establish causality.

LEVEL OF EVIDENCE: Level IV, therapeutic/care management.