≥65 Years Rib Fractures: 30-day post-discharge mortality comparing advanced analgesia/regional intervention vs no intervention

Background:

Rib fractures in older adults are a marker of physiological vulnerability and are associated with complications that can extend well beyond the inpatient stay. While advanced thoracic analgesia and regional techniques are widely used to reduce pain, splinting, and respiratory deterioration, the relationship between these interventions and post-discharge outcomes is less clearly described. We evaluated 30-day post-discharge mortality in patients aged ≥65 admitted with rib fractures, comparing those who received advanced thoracic analgesia/regional intervention versus those who did not.

Methods:

We performed a retrospective audit of consecutive rib fracture admissions between April and June 2025. Inclusion criteria were age ≥65 and discharge alive from the index admission. Intervention was pre-defined as a thoracic epidural or a named regional block (e.g. erector spinae plane block), and/or rib fixation. Patients not receiving any of these were classified as no intervention. The primary outcome was all-cause death within 30 days of hospital discharge. Groups were compared using Fisher’s exact test, with unadjusted risk ratio (RR) and 95% confidence interval (CI) reported.

Results:

Eighty-seven patients met the inclusion criteria (31 in the intervention group; 56 in the no-intervention group). Thirty-day post-discharge mortality was 9.7% (3/31) in the intervention group versus 17.9% (10/56) in the non-intervention group (RR 0.54, 95% CI 0.16–1.82; p=0.36), an absolute difference of 8.2%. Although the difference was directionally favourable, the confidence interval was wide, indicating limited certainty from this single-quarter cohort.

Conclusion:

Among patients aged ≥65 discharged alive after rib fracture admission, advanced thoracic analgesia/regional intervention was associated with a lower 30-day post-discharge mortality. The sample size limits statistical certainty; however, expanding to a larger multi-year cohort and even a multi-centre study should improve certainty, support adjusted analyses, and better clarify whether observed differences reflect genuine intervention effects, confounding factors, neither or both.