Long-term quality of life and chronic pain after surgical vs. non-operative treatment of rib fractures: systematic review and meta-analysis

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, I 2 = 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.