The Transfer Advantage: Regional Chest Wall Care Without Delay

Background Rurality is associated with prehospital mortality and delayed definitive care after traumatic injury. Whether rurality is associated with operative timing or outcomes of surgical stabilization of rib fractures (SSRF) is unknown. Methods We performed a retrospective cohort study of 173 consecutive patients undergoing SSRF at a Level I trauma center from 2016 to 2025. Patients were stratified by rurality, defined by Rural-Urban Commuting Area codes (urban 1-3, rural ≥4). The primary outcome was time to SSRF as measured from initial hospital presentation. Results Rural patients (n = 105) and urban patients (n = 68) experienced similar median time to surgery (3.1 vs 3.4 days, P = 0.74) and rates of SSRF within 72 hours (50% vs 47%, P = 0.75). This was despite rural patients having greater injury severity, more frequent interfacility transfer (50% vs 21%; OR 3.78; 95% CI 1.87-7.80, P < 0.05), and increased intensive care unit admission (53% vs 21%, P < 0.05). Respiratory complications (26% vs 24%), median length of stay (10.9 vs 9.4 days), and 30-day mortality (4% vs 0%) were not significantly different between groups (all P > 0.05). Conclusions No differences in operative timing or short-term outcomes were observed between rural and urban patients undergoing SSRF. These findings suggest dedicated chest wall injury centers may mitigate geographic disparities in timing and outcomes of SSRF.