Outcomes of surgical stabilization of rib fractures in COPD patients: A propensity-matched analysis stratified by injury pattern.

Authors

Amir Ebadinejad, Sara Saeidishahri, Ya-Huei Li, Stephen Thompson, Jane Keating, Daniel Ricaurte, Juan Cobar, Nishant Merchant

Published in

The journal of trauma and acute care surgery. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

Patients with chronic obstructive pulmonary disease (COPD) who sustain rib fractures are at increased risk of respiratory complications due to impaired pulmonary reserve. Surgical stabilization of rib fractures (SSRFs) has demonstrated benefits in selected trauma populations; however, its impact in patients with COPD remains unclear.
Adult COPD patients aged ≥35 with multiple rib fractures were identified from the National Trauma Data Bank (2017-2022). Patients were stratified according to treatment strategy: SSRF versus nonoperative management. Propensity score matching (1:1) was performed to balance baseline characteristics and injury severity between groups. Primary outcomes included in-hospital mortality and resource utilization. Subgroup analyses compared early fixation within 72 hours with delayed fixation after 72 hours, stratified by the presence of flail chest.
Among 21,757 eligible patients, 626 underwent SSRF and 21,131 received nonoperative management. In-hospital mortality did not differ significantly between the SSRF and nonoperative groups. However, SSRF was associated with greater resource utilization, including higher rates of mechanical ventilation (45.5% vs. 28.9%; p<0.001), unplanned intensive care unit (ICU) admission (11.7% vs. 7.1%; p=0.013), and unplanned intubation (13.9% vs. 8.9%; p=0.013), as well as longer ICU stay (7 vs. 3 d; p<0.001) and hospital stay (14 vs. 10 d; p<0.001). Early fixation was associated with shorter ICU and hospital stays in both flail and non-flail chest subgroups. In patients without flail chest, early SSRF was also associated with lower ventilation rates (31.9% vs. 47.1%; p=0.007). Mortality did not differ by SSRF timing.
In COPD patients with multiple rib fractures, SSRF was not associated with a significant mortality benefit and was associated with greater respiratory support requirements and resource utilization than nonoperative management. However, early SSRF was associated with shorter ICU and hospital stays in both flail and non-flail injury patterns and with reduced mechanical ventilation in patients without flail chest. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
Retrospective Cohort Study; Level III.

PMID:
42468033
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

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