Title : Timing of Surgical Stabilisation of Rib Fractures (SSRF) and clinical outcomes at a major trauma centre: A retrospective cohort study
Abstract:
Background: Surgical Stabilisation of Rib Fractures (SSRF) is increasingly used for patients with severe chest wall injuries. Early fixation, particularly within 72 hours of injury, has been proposed to improve respiratory outcomes and reduce intensive care requirements; however, the optimal timing of SSRF remains uncertain. This study evaluated the association between SSRF timing and postoperative outcomes at a UK major trauma centre.
Methods: We conducted a retrospective cohort study of adult patients who underwent SSRF between April 2019 and May 2024. Patients were stratified according to time from injury to surgery (≤72 hours vs. >72 hours) and time from surgical decision to surgery (≤48 hours vs. >48 hours). Primary outcomes were postoperative complications and mortality. Intensive Care Unit (ICU) Length of Stay (LOS) was assessed as a secondary outcome. Categorical variables were analysed using Fisher’s exact test, continuous variables using the Mann–Whitney U test, and multivariable logistic regression was used to assess independent associations between surgical timing and postoperative complications.
Results: Sixty-three patients underwent SSRF, with a median age of 58 years and 84% being male. Forty-six patients (69.8%) underwent SSRF within 72 hours of injury. Overall, postoperative complications occurred in 11 patients (17.5%). There was no significant difference in complication rates between patients undergoing SSRF within 72 hours and those undergoing later fixation (17.4% vs. 15.8%, p=0.999). Mortality was low overall at 4.8%, with no significant difference between groups (4.3% vs. 5.3%, p=0.9999). Multivariable logistic regression demonstrated no significant independent association between surgical timing and postoperative complications. However, patients undergoing SSRF within 72 hours had a significantly shorter ICU LOS compared with those undergoing later surgery (median 5 vs. 13 days, p=0.002).
Conclusion: In this single-centre cohort, early SSRF within 72 hours of injury was associated with a significantly shorter ICU LOS but was not associated with reduced postoperative complications or mortality. These findings suggest that early fixation may improve ICU resource utilisation and support recovery, although surgical timing should be individualised according to patient condition, injury severity, perioperative optimisation, and institutional resources. Larger prospective multicentre studies are required to establish the optimal timing of SSRF and its impact on clinical outcomes.
Keywords: Surgical stabilisation of rib fractures; SSRF; rib fractures; chest trauma; surgical timing; ICU length of stay; major trauma
