Long-term quality of life and chronic pain after surgical vs. non-operative treatment of rib fractures: systematic review and meta-analysis - Report - MDSpire
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Long-term quality of life and chronic pain after surgical vs. non-operative treatment of rib fractures: systematic review and meta-analysis
Long-term Quality of Life and Chronic Pain After Rib Fracture Surgery vs. Non-surgical Care
Overview
This systematic review and meta-analysis of 14 studies with 1,947 patients found no significant long-term difference in health-related quality of life (HRQoL) between surgical stabilization of rib fractures (SSRF) and non-operative management. However, SSRF was associated with a higher risk of chronic chest wall pain at ≥3 months post-injury compared to non-surgical treatment.
Background
Traumatic rib fractures are common and often lead to significant morbidity including prolonged pain and impaired functional recovery. While SSRF has shown benefits in short-term respiratory outcomes, its impact on long-term patient-centered outcomes such as HRQoL and chronic pain remains unclear. Chronic chest wall pain after rib fractures can result from multiple factors including nerve injury and surgical scarring. Understanding the long-term effects of SSRF versus non-operative care is critical for guiding treatment decisions.
Data Highlights
Outcome
Number of Studies
SSRF Patients
Non-operative Patients
Effect Size (95% CI)
Significance
Long-term HRQoL (≥3 months)
7
334
336
SMD 0.10 (−0.38 to 0.57)
p = 0.69 (no significant difference)
Chronic chest wall pain (≥3 months)
5
213
912
RR 1.28 (1.03–1.58)
Higher risk with SSRF
Continuous pain scores
4
Not specified
Not specified
No significant difference
Not significant
Tracheostomy rates
Not specified
Not specified
Not specified
No significant difference
Not significant
Key Findings
No significant difference in long-term HRQoL between SSRF and non-operative management (SMD 0.10, p=0.69).
Patients undergoing SSRF had a 28% higher risk of chronic chest wall pain at ≥3 months post-injury (RR 1.28).
Continuous pain score assessments showed no significant difference between SSRF and non-operative groups.
Tracheostomy rates were similar between surgical and non-surgical treatment groups.
High heterogeneity was noted in HRQoL studies (I2 = 89%), reflecting variability in study designs and populations.
Clinical Implications
Clinicians should be aware that SSRF may not confer long-term quality of life benefits compared to non-operative care and may increase the risk of chronic chest wall pain. Patient counseling should include discussion of potential chronic pain risks associated with surgical fixation. Further prospective studies with standardized long-term outcome assessments are needed to better define the role of SSRF in managing rib fractures.
Conclusion
SSRF does not demonstrate a clear advantage in long-term HRQoL and may be associated with increased chronic chest wall pain compared to non-operative management. These findings highlight the need for cautious patient selection and further research on long-term outcomes.
References
Systematic Review Registration PROSPERO CRD420251245598 -- Comparative Analysis of Long-term Quality of Life and Chronic Pain Following Surgical and Non-surgical Approaches for Rib Fractures
