Long-term quality of life and chronic pain after surgical vs. non-operative treatment of rib fractures: systematic review and meta-analysis
Front Surg. 2026 Mar 30;13:1774082. doi: 10.3389/fsurg.2026.1774082. eCollection 2026.
ABSTRACT
BACKGROUND: Surgical stabilization of rib fractures (SSRF) is increasingly used, yet its long-term impact on patient-centered outcomes remains uncertain. Evidence regarding health-related quality of life (HRQoL) and chronic chest wall pain after SSRF vs. non-operative management is lacking.
METHODS: We conducted a systematic review and meta-analysis of studies evaluating SSRF and non-operative treatment in adults with traumatic rib fractures. Primary outcomes were long-term HRQoL (≥3 months) and chronic chest wall pain. Secondary outcomes included tracheostomy. Effect sizes were pooled as standardized mean differences (SMDs), risk ratios (RRs), or mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS: Fourteen studies involving 1,947 patients met the inclusion criteria. Seven studies (n = 670; 334 SSRF, 336 non-operative) reported HRQoL, showing no significant difference between groups (SMD 0.10, 95% CI -0.38 to 0.57, p = 0.69, I2 = 89%). Five studies (SSRF n = 213; non-operative n = 912) reported chronic pain ≥3 months, with a higher risk after SSRF (RR 1.28, 95% CI 1.03-1.58). Four studies assessing continuous pain scores showed no significant difference. Tracheostomy rates did not differ significantly between groups.
CONCLUSIONS: SSRF has no demonstrated long-term HRQoL benefit and may be associated with more chronic chest wall pain than non-operative management. Prospective studies with standardized long-term assessments are needed.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251245598.
PMID:41982375 | PMC:PMC13070923 | DOI:10.3389/fsurg.2026.1774082