Comparison of Surgical and Conservative Treatment Outcomes in Elderly Patients with Rib Fractures: A Propensity Score-Matched Retrospective Cohort Study and Subgroup Analysis

Background Rib fractures are a common and clinically significant consequence of blunt chest trauma. With the global population aging, elderly patients have become a significant component of thoracic trauma patients. Improvements in fixation materials and shifts in treatment approaches have changed how rib fractures are diagnosed and managed. Despite these advances, research focused specifically on rib fractures in older adults remains limited. Methods This retrospective study was conducted at Shanghai Sixth People's Hospital, the largest trauma center in Shanghai. We included elderly patients treated in the Department of Thoracic Surgery at Shanghai Sixth People's Hospital between June 2016 and June 2024. Using propensity score matching (PSM), we compared outcomes between patients who received conservative management and those who underwent surgical stabilization of rib fractures (SSRF). Subgroup analyses were performed to investigate treatment benefits across diverse patient populations. Results A total of 1,252 elderly patients were included in this study, comprising those who received conservative treatment (n = 626) and SSRF(n = 626). In terms of clinical outcomes and long-term prognosis, patients in the surgical group had longer hospital stays but significantly shorter intensive care unit (ICU) lengths of stay. Although they experienced a higher incidence of short-term pneumonia, none progressed to respiratory failure or died. Notably, patients in the surgical group demonstrated significantly greater improvement in long-term quality of life compared to those in the conservative group. Subgroup analysis revealed that male gender, overweight status (Body mass index > 24), specific comorbidities (coronary heart disease), and concomitant injuries (traumatic brain injury, pelvic fracture) were associated with variability in clinical outcomes. Conclusions SSRF can accelerate early recovery, shorten ICU length of stay, and improve short-term quality of life in elderly patients, albeit with an increased risk of short-term pneumonia. Clinical decisions should be individualized, taking into account comorbidities, functional status, and patient preferences.