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

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. 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. 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). 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.