Impact of inflammatory biomarkers and surgical interventions on one-month recovery after rib fractures: a propensity-matched cohort study

BACKGROUND: Rib fractures are common, but the value of surgical stabilization and inflammatory biomarkers for early recovery remains uncertain. We assessed the impact of pretreatment inflammatory indices and surgical stabilization on 1-month outcomes after rib fractures. METHODS: We retrospectively analyzed adults with radiologically confirmed rib fractures treated between 2020 and 2023. Primary outcomes were thoracic complications and ongoing oral analgesic use at 1 month; the secondary outcome was total hospital cost. Propensity score matching (1:2) was used to compare surgical with non-surgical management, and multivariable models explored associations between inflammatory indices and outcomes. RESULTS: After PSM (60 surgical vs. 117 non-surgical patients), surgical intervention was associated with a significant increase in total cost (≈ 30,800 CNY; P < 0.001) without reducing 1-month thoracic complications or analgesic use. Pre-existing thoracic complications independently predicted higher odds of 1-month complications (OR 4.05, 95% CI 1.08–18.15; P = 0.048), whereas comorbidities were associated with reduced risk (OR 0.29, 95% CI 0.08–0.89; P = 0.043). Higher systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) were positively correlated with Injury Severity Score. In surgical patients, higher lymphocyte-to-monocyte ratio (LMR) and hemoglobin (HGB) levels were associated with a lower likelihood of ongoing analgesic use at 1 month (OR 0.70, 95% CI 0.46–0.95; P = 0.046). CONCLUSION: Surgical stabilization of rib fractures incurs higher costs without clear short-term clinical benefit. Elevated SII and NLR reflect greater injury severity, while LMR and HGB levels are linked to analgesic requirements, suggesting potential biomarker-guided approaches for individualized pain management that warrant further validation.