This single-center retrospective cohort study assessed whether surgical stabilization of rib fractures (SSRF) is associated with differences in pulmonary outcomes compared with nonoperative management (NONOP) after controlling for radiographic injury severity measured by RibScore. The analysis used data from an ACS-verified Level I trauma center covering January 2016 to April 2023.
Adults with CT-confirmed blunt traumatic rib fractures were identified and classified by treatment strategy: SSRF versus NONOP. The RibScore—calculated from initial CT imaging—was used to quantify radiographic chest wall injury severity. The study design was retrospective and single-center.
The primary outcome was a composite adverse pulmonary outcome defined as any of the following events: pneumonia, invasive mechanical ventilation for more than 48 hours, or tracheostomy. The study additionally assessed respiratory failure as a separate outcome. Other outcome components and secondary endpoints are not detailed in the abstract.
Multivariable logistic regression models were constructed to estimate adjusted associations between SSRF and outcomes. Models adjusted for demographics, RibScore, thoracic and extra-thoracic injury severity measures, calendar year, chronic obstructive pulmonary disease (COPD), and current smoking status. The abstract reports adjusted odds ratios (aORs) with 95% confidence intervals and p values for the composite outcome and respiratory failure.
The cohort included 3,066 patients with blunt rib fractures. Of these, 444 underwent SSRF and 2,622 were managed nonoperatively. Patients selected for SSRF had greater radiographic chest wall injury severity: the median RibScore was 2 for the SSRF group versus 0 for the NONOP group (p < 0.001), indicating that surgical patients had more severe imaging-based injury at presentation.
The composite adverse pulmonary outcome occurred in 14.6% of patients who underwent SSRF and in 16.6% of patients treated nonoperatively. The abstract does not report detailed unadjusted event counts for individual components (pneumonia, prolonged ventilation, tracheostomy) beyond the composite rate.
After multivariable adjustment for demographics, RibScore, thoracic and extra-thoracic injury severity, calendar year, COPD, and smoking status, SSRF was associated with significantly lower adjusted odds of the composite adverse pulmonary outcome: aOR 0.57, 95% CI 0.40–0.81; p = 0.002.
SSRF was also associated with lower adjusted odds of respiratory failure (aOR 0.57, 95% CI 0.39–0.83; p = 0.004). These associations indicate that, within this cohort and after accounting for measured confounders including radiographic injury severity, operative stabilization correlated with reduced odds of the prespecified pulmonary endpoints.
In this single-center cohort, patients treated with SSRF had greater radiographic chest wall injury severity on CT but experienced lower adjusted odds of a composite adverse pulmonary outcome and of respiratory failure compared with patients managed nonoperatively. The findings suggest that SSRF may confer pulmonary outcome benefits even among patients with higher RibScore-defined injury severity when adjustment for confounders is applied.
Key limitations inherent to the report include its retrospective, single-center design and possible residual confounding despite multivariable adjustment. The abstract does not report timing of SSRF relative to injury, specific selection criteria for surgery, perioperative protocols, or granular outcome component counts beyond the composite and respiratory failure results. These unreported details limit assessment of causality and generalizability.
The study was approved by the Institutional Review Board of the University of Nebraska Medical Center with waiver of informed consent due to retrospective design. Disclosure information provided notes that one author, Dr. Zachary Bauman, is a paid educational consultant for several device companies. Full disclosure forms are available as supplemental content per the publication.
Sources and citation
This summary is based solely on the abstract and metadata of the published article: Muldiiarov V et al., Eur J Trauma Emerg Surg. 2026;52(1):264. DOI: 10.1007/s00068-026-03306-1. The abstract provided the cohort size (n = 3,066), group counts (444 SSRF; 2,622 NONOP), median RibScore values (2 vs 0), composite outcome rates (14.6% vs 16.6%), and adjusted odds ratios with 95% confidence intervals and p values for the reported outcomes. The abstract did not report additional granular methods or outcome details.