Characteristics of the study population.

Background
Obesity is a global health issue with increasing prevalence. Surgical procedures, such as surgical stabilization of rib fractures (SSRF), may be affected by obesity-related complications. The objective of the study is to investigate the effects of obesity on SSRF outcomes in multiple rib fractures.
Methods
This retrospective study analyzed data from adults aged ≥ 20 years in the Nationwide Inpatient Sample (NIS) database diagnosed with multiple rib fractures who underwent SSRF between 2005 and 2018. It investigated the relationship between obesity and in-patient outcomes, such as discharge status, length of stay (LOS), in-hospital mortality, hospital costs, and adverse events using logistic and linear regression analyses.
Results
Analysis of data from 1,754 patients (morbidly obese: 87; obese: 106; normal weight: 1,561) revealed that morbid obesity was associated with longer LOS (aBeta = 0.07, 95% CI: 0.06, 0.07), higher hospital costs (aBeta = 47.35, 95% CI: 38.55, 56.14), increased risks of adverse events (aOR = 1.63, 95% CI: 1.02, 2.61), hemorrhage/need for transfusion (aOR = 1.77, 95% CI: 1.12, 2.79) and mechanical ventilation ≥ 96 hours (aOR = 2.14, 95% CI: 1.28, 3.58) compared to normal weight patients. Among patients with flail chest, morbid obesity was significantly associated with tracheostomy (aOR = 2.13, 95% CI: 1.05, 4.32), ARDS/respiratory failure (aOR = 2.01, 95% CI: 1.09, 3.70), and mechanical ventilation ≥ 96 hours (aOR = 2.80, 95% CI: 1.47, 5.32). In contrast, morbid obesity had no significant associations with these adverse respiratory outcomes among patients without a flail chest (p > 0.05).
Conclusions
Morbid obesity is associated with adverse outcomes following SSRF for multiple rib fractures, especially for flail chest patients.

### 研究背景
肥胖是患病率持续攀升的全球性公共卫生问题。外科手术操作（如肋骨骨折手术固定术（Surgical Stabilization of Rib Fractures, SSRF））可能会受到肥胖相关并发症的影响。本研究旨在探究肥胖对多发肋骨骨折患者行SSRF术后临床结局的影响。

### 研究方法
本项回顾性研究分析了2005年至2018年间，收录于全国住院患者样本（Nationwide Inpatient Sample, NIS）数据库中，年龄≥20岁、确诊为多发肋骨骨折且接受SSRF治疗的成年患者数据。研究采用logistic回归与线性回归分析方法，探究肥胖与患者住院结局的关联，涵盖出院状态、住院时长（Length of Stay, LOS）、院内死亡率、住院费用及不良事件。

### 研究结果
对1754例患者的临床数据进行分析（病态肥胖组87例，肥胖组106例，正常体重组1561例），结果显示：与正常体重患者相比，病态肥胖患者的住院时长更长（校正β=0.07，95%置信区间[CI]：0.06, 0.07）、住院费用更高（校正β=47.35，95%CI：38.55, 56.14），不良事件发生风险更高（校正优势比[aOR]=1.63，95%CI：1.02, 2.61），出血/输血需求风险更高（aOR=1.77，95%CI：1.12, 2.79），且机械通气时长≥96小时的风险更高（aOR=2.14，95%CI：1.28, 3.58）。在连枷胸患者亚组中，病态肥胖与气管切开术（aOR=2.13，95%CI：1.05, 4.32）、急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome, ARDS）/呼吸衰竭（aOR=2.01，95%CI：1.09, 3.70）及机械通气时长≥96小时（aOR=2.80，95%CI：1.47, 5.32）均存在显著关联。与之相反，在非连枷胸患者中，病态肥胖与上述不良呼吸结局无显著统计学差异（p>0.05）。

### 研究结论
多发肋骨骨折患者行SSRF治疗后，病态肥胖与不良术后结局显著相关，这一关联在连枷胸患者中尤为突出。