Quantifying the expense of deferring surgical stabilization of rib fractures: operative management of rib fractures is associated with significantly lower charges.

Surgical stabilization of rib fractures (SSRF) remains a relatively controversial operation, which is often deferred due to concern about expense. The objective of this study was to determine the charges for SSRF versus medical management during index admission for rib fractures. We hypothesize that SSRF is associated with increased charge as compared to medical management.
This is a retrospective chart review of a prospectively maintained database of patients with ≥3 displaced rib fractures admitted to a level-1 trauma center from 2010-2019. Patients who underwent SSRF (operative management, OM) were compared to those managed medically (nonoperative management, NOM). The total hospital charge between OM and NOM was compared with univariate analysis, followed by backwards stepwise regression and mediation analysis.
Overall, 279 patients were included. The majority (75%) were male, the median age was 54 years, and the median injury severity score (ISS) of 21. 182 patients underwent OM, whereas 97 underwent NOM. Compared to NOM, OM patients had a lower ISS (18 versus 22, p=0.004), less traumatic brain injury (14% versus 31%, p=0.0006), shorter length of stay (LOS; 10 versus 14 days, p=0.001), and decreased complications. After controlling for the differences between OM and NOM patients, OM was significantly associated with decreased charges (β=$35,105, p=0.01). Four other predictors, with management, explained 30% of the variance in charge (R =0.30, p<0.0001): scapular fracture (β=$471,967, p<0.0001), ISS per unit increase (β=$4,139, p<0.0001), long bone fracture (β=$52,176, p=0.01), bilateral rib fractures (β=$34,392, p=0.01), and GCS per unit decrease (β=$17,164, p<0.0001). The difference in charge between NOM and OM management was most strongly, though only partially, mediated by LOS.
Our analysis found that OM, as compared to NOM, was independently associated with decreased hospital charges. These data refute the prevailing notion that SSRF should be withheld due to concerns for increased cost.
Level II, economic.