Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study

1. In patients with traumatic rib fractures, the number of rib fractures was an independent risk factor for venous thromboembolism (VTE).

2. Surgical fixation of isolated rib fractures involving ≥3 ribs reduced the incidence of VTE compared with conservative treatment.

Evidence Rating Level:1 (Excellent)

Traumatic rib fractures increase VTE risk due to reduced mobility, trauma impact, and treatment interventions. Limited data exist on VTE incidence and risk factors in acute chest trauma patients, especially those with rib fractures. This retrospective study identified 5774 cases of traumatic rib fractures between October 2020 and September 2021 from 33 hospitals affiliated with the China Chest Injury Research Society to assess VTE incidence and contributing factors in this population. Of these patients, 466 patients (mean age [SD], 55.1 [13.7]; 31.3% female) experienced in-hospital VTE (overall VTE incidence of 8.1%).  Patients with isolated rib fractures had a significantly lower incidence of VTE compared with patients who had rib fractures accompanied by other injuries (4.4% vs. 12.0%, P < 0.01). In a multifactorial analysis of all cases (combined and isolated rib fractures), age, smoking, prophylactic drug anticoagulation therapy, number of rib fractures, combined vertebral fractures, combined pelvic fractures, combined lower extremity fractures, and ventilator-assisted ventilation were independent risk factors for VTE. Patients who underwent surgical fixation of rib fractures had a lower risk of VTE (OR = 0.219, 95% CI: 0.164–0.292, P < 0.001). Among patients with isolated rib fractures, age, smoking, prophylactic drug anticoagulation therapy, number of rib fractures, and ventilator-assisted ventilation remained independent risk factors for VTE, and surgical fixation continued to be a protective factor (OR = 0.199, 95% CI: 0.118–0.335, P < 0.001). When examining surgical fixation further, there was no difference in VTE incidence between surgical and conservative treatment in patients with isolated rib fractures involving 1-2 ribs (0 vs. 1.5%, P = 0.786), while in patients with 3–6 and ≥ 7 ribs fractured, surgical treatment significantly lowered VTE incidence compared with conservative treatment (1.8% vs. 5.5% and 3.8% vs. 12.1%, respectively; P < 0.001). Overall, these findings demonstrate a substantial incidence of VTE in patients with rib fractures, correlated with the number of rib fractures. Targeted thromboprophylaxis and surgical stabilization can mitigate this VTE risk.

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