Smoking as a Marker: Identifying High-Risk Patients After Ground Level Fall Chest Trauma

Rib fractures resulting from ground level falls are associated with substantial morbidity, particularly among older adults. Smoking is known to impair pulmonary function and healing, yet its relationship with outcomes following ground level fall-related rib fractures remains incompletely characterized. METHODS: A retrospective review of 305 adults with rib fractures sustained from ground level falls was performed. Smoking exposure was categorized as ever versus never. Continuous variables were summarized using means with standard deviations or medians with interquartile ranges and compared using parametric or nonparametric tests as appropriate. Categorical variables were compared using odds ratios with 95% confidence intervals, and baseline characteristics were assessed for potential confounding. Statistical significance was defined as p < 0.05. RESULTS: Ever-smokers experienced longer hospitalizations and higher post-discharge mortality compared with never-smokers. While ever-smokers demonstrated lower documented odds of select acute pulmonary complications, these differences likely reflect variation in baseline pulmonary disease, diagnostic practices, or care pathways rather than a protective physiologic effect. In contrast, smoking status was strongly associated with adverse downstream outcomes, including prolonged length of stay and post-discharge mortality. CONCLUSION: In patients with ground level fall-related rib fractures, smoking history is associated with worse downstream outcomes despite lower rates of documented in-hospital pulmonary complications. Smoking may represent a marker of broader vulnerability, encompassing comorbidity burden, substance use, and social factors that influence recovery and survival. These findings underscore the importance of risk stratification strategies that extend beyond acute pulmonary events to address post-discharge outcomes in this population.