Variations in chest wall stabilization practices worldwide: a survey among surgeons of European Association for Cardio-Thoracic Surgery (EACTS)

Abstract

Surgical stabilization of rib fractures (SSRF) is increasingly recognized as a key component in the management of severe blunt thoracic trauma, yet its adoption remains inconsistent worldwide. This study aimed to evaluate international practice patterns for SSRF among the members of the European Association for Cardio-Thoracic Surgery (EACTS), and highlight gaps requiring further research and standardization. A 25-item electronic questionnaire containing both single and multiple-choice questions was developed and distributed to all EACTS members, following EACTS guideline committee’s approval. The survey assessed surgeon demographics, institutional characteristics, indications and contraindications for SSRF, timing of intervention, operative techniques and materials used, with postoperative management strategies. Responses were collected over four weeks with duplicate prevention measures. Data were analyzed using descriptive statistics. Total of 206 surgeons from 56 countries participated, predominantly thoracic or cardiothoracic surgeons based in academic institutions. Flail chest was broadly accepted as an indication for SSRF (85% agreement). Non-flail indications, contraindications, and timing of surgery showed marked heterogeneity. Most respondents favored early intervention within 24–72 h and open surgical approaches using plate-and-screw fixation, while standardized scoring systems and minimally invasive techniques were infrequently employed. Postoperative management was more uniform; however surgeon-reported impressions of common complications included persistent pain, implant-related complications, and surgical site infection. Significant international variability exists in the application of SSRF among EACTS-affiliated surgeons, despite expanding evidence supporting its use. While consensus has emerged for flail chest, inconsistent practices in non-flail indications, timing, surgical strategies, and follow-up underline the need for harmonized international guidelines, standardized assessment tools, and structured multidisciplinary care pathways to improve outcomes in chest wall trauma.