Long-term pulmonary function, thoracic pain, and quality of life in patients with one or more rib fractures

BACKGROUND Long-term outcomes after rib fractures and the effect of treatment modality or chest wall injury severity on these outcomes remains uncertain. This retrospective cohort study evaluated the long-term pulmonary function, thoracic pain, and quality of life in patients admitted with rib fractures. METHODS Patients admitted with rib fractures between January 1, 2012, and December 1, 2019, were included. Data on long-term outcomes were collected during one follow-up visit. Patients were stratified by chest wall injury severity (one or two rib fractures, ≥3 rib fractures, or a flail chest) and treatment modality (surgical stabilization of rib fractures [SSRF] or nonoperative management). Multivariable analysis was performed to compare outcomes after SSRF with nonoperative treatment in patients with three or more rib fractures. RESULTS In total, 300 patients were included. The median follow-up was 39 months (P 25 –P 75 , 18–65 months). At follow-up, the corrected forced vital capacity returned to 84.7% (P 25 –P 75 , 74.3–93.7) and the forced expiratory volume in 1 second to 86.3% (P 25 –P 75 , 75.3–97.0) of the predicted reference values. Quality of life was determined using the Short Form-12 version 2 and EuroQoL-5D-5L. The Short Form-12 version 2 physical and mental component summary were 45 (P 25 -P 75 , 38–54) and 53 (P 25 -P 75 , 43–60), respectively. The EuroQoL-5D-5L utility score was 0.82 (P 25 –P 75 0.66–0.92) and visual analog scale score 75 (P 25 –P 75 70–85). This indicated a quality of life within normal population ranges. Moderate to severe thoracic pain was reported by 64 (21.3%) patients. Long-term outcomes returned to values within population ranges and were similar across chest wall injury severity and for patients treated with SSRF or nonoperatively. CONCLUSION While long-term pulmonary function and quality of life recover to values considered normal, subjective thoracic complaints, such as pain and dyspnea, remain frequently present following rib fractures. No effect of chest wall injury severity or treatment modality on long-term outcomes was demonstrated. LEVEL OF EVIDENCE Therapeutic, level III