European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Surgical stabilization of rib fractures in a high-altitude trauma cohort: in-hospital clinical outcomes and resource use in a propensity score-weighted retrospective cohort study.
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Wan Qian, Sun Qiang, Li Weinan, Yundan Ciren, Hu Liwen, Shen Yi
Аннотация
PURPOSE: Surgical stabilization of rib fractures (SSRF) is increasingly used in the management of traumatic rib fractures, but its in-hospital outcomes in high-altitude trauma settings remain uncertain. We evaluated the association of SSRF with in-hospital pulmonary complications and length of stay in a high-altitude (≈ 3,500 m) trauma system.
METHODS: We conducted a single-center retrospective cohort study of adults with CT-confirmed traumatic rib fractures admitted from 2015 to 2023 and managed with SSRF or non-operative management. Confounding was addressed using stabilized inverse probability of treatment weighting (IPTW) with augmented outcome models; overlap weighting, propensity score matching, and time-dependent exposure analysis were used as sensitivity analyses. The primary outcome was a composite of in-hospital pneumonia, atelectasis, or respiratory failure. Pulmonary risk ratios (RRs) were estimated using modified Poisson regression, while ICU and hospital length of stay were analyzed using log-transformed weighted models.
RESULTS: Among 324 patients, 121 underwent SSRF and 203 received non-operative management. Before adjustment, SSRF patients had greater injury severity. In IPTW-augmented analyses, the pulmonary estimate was imprecise (RR 0.86, 95% CI 0.23-3.21; P = 0.822), and no significant difference was detected in ICU length of stay (exp[β] 1.04, 95% CI 0.97-1.10; P = 0.286). Hospital length of stay was longer with SSRF (exp[β] 2.31, 95% CI 2.02-2.65; P < 0.001).
CONCLUSION: Adjusted analyses found no statistically detectable difference in pulmonary complications or ICU length of stay, although the pulmonary estimate remained imprecise and does not establish equivalence or safety. SSRF was associated with longer hospital length of stay.
TRIAL REGISTRATION: Not applicable.
METHODS: We conducted a single-center retrospective cohort study of adults with CT-confirmed traumatic rib fractures admitted from 2015 to 2023 and managed with SSRF or non-operative management. Confounding was addressed using stabilized inverse probability of treatment weighting (IPTW) with augmented outcome models; overlap weighting, propensity score matching, and time-dependent exposure analysis were used as sensitivity analyses. The primary outcome was a composite of in-hospital pneumonia, atelectasis, or respiratory failure. Pulmonary risk ratios (RRs) were estimated using modified Poisson regression, while ICU and hospital length of stay were analyzed using log-transformed weighted models.
RESULTS: Among 324 patients, 121 underwent SSRF and 203 received non-operative management. Before adjustment, SSRF patients had greater injury severity. In IPTW-augmented analyses, the pulmonary estimate was imprecise (RR 0.86, 95% CI 0.23-3.21; P = 0.822), and no significant difference was detected in ICU length of stay (exp[β] 1.04, 95% CI 0.97-1.10; P = 0.286). Hospital length of stay was longer with SSRF (exp[β] 2.31, 95% CI 2.02-2.65; P < 0.001).
CONCLUSION: Adjusted analyses found no statistically detectable difference in pulmonary complications or ICU length of stay, although the pulmonary estimate remained imprecise and does not establish equivalence or safety. SSRF was associated with longer hospital length of stay.
TRIAL REGISTRATION: Not applicable.