Comparison of long-term outcomes from rib fractures for patients undergoing both operative and non-operative management: a survey analysis

Introduction Surgical stabilization of rib fractures (SSRF) has been gaining popularity for the treatment of rib fractures. Limited literature exists regarding the long-term effects of SSRF versus non-operative (NO) intervention. The goal of this study is to better understand these long-term effects, hypothesizing SSRF patients have better outcomes. Methods IRB approved survey study at our Level I trauma center. Patients suffering rib fractures from 1/2017 through 1/2019 were surveyed via phone call and asked five questions. Basic demographics obtained. The five survey questions asked: "Are you still experiencing pain from your rib fractures?"; "If yes, how would you rate your pain 1-10?"; "Are you back to your baseline activity level?"; "If no, is this related to your rib fractures?"; "Do you feel your rib fractures moving/clicking?" Paired t test, Chi square, and median tests were utilized. Significance was set at p < 0.05. Results 527 patients were called with 228 unsuccessfully reached. 47 refused to participate. 252 patients (47.8%) participated in the survey; 78 SSRF and 174 NO. Age and gender were similar between cohorts. Majority of patients suffered blunt trauma. No significant difference between ISS; 15 SSRF vs 14 NO. SSRF patients had worse chest trauma with median chest AIS of 3 (IQR 3-4) vs 3 (IQR 3-3) for NO (p < 0.001). Response to survey questions revealed similar incidences of pain between SSRF and NO cohorts (28.2% vs 27.6%; p = 0.939), however decreased pain scores for SSRF group (2 vs 4; p = 0.006). Return to baseline activity was better for the SSRF group (75.6% vs 56.3%; p = 0.143) and the incidence of rib fractures being the reason for patients not returning to baseline was decreased (26.3% vs 44.7%; p = 0.380). Lastly, SSRF resulted in significantly less movement of rib fractures (3.8% vs 13.8%; p = 0.031). Conclusion Patients who undergo SSRF show significant long-term improvements in pain scores and better return to baseline function with less overall issues from their rib fractures compared to those managed non-operatively.