Effect of management in intermediate care unit versus conventional hospitalization on long-term mortality and autonomy in patients with rib fractures aged 75 years and older: a retrospective study

PURPOSE: Rib fractures in older adults are associated with substantial morbidity and mortality. Management in an intermediate care unit (IMCU) may improve outcomes, but its long-term benefit remains uncertain. We compared IMCU versus conventional management regarding 12-month mortality and autonomy in patients aged ≥ 75 years with rib fractures. METHODS: We conducted a retrospective observational cohort study in two Lyon teaching hospitals (Hôpital Edouard Herriot and Hôpital Lyon Sud, Hospices Civils de Lyon, France) between January 2015 and December 2019. The primary outcome was a composite of death or institutionalization within 12 months of hospital admission. Secondary outcomes included discharge modality, opioid prescription at discharge, hospital length of stay, unplanned readmission within 6 months, and ADL/IADL scores. Logistic regression was adjusted for hospitalization unit, age, sex, pre-existing institutionalization, and associated injuries. RESULTS: A total of 196 patients were included: 126 (64%) in the conventional group and 70 (36%) in the IMCU group. Death or institutionalization within 12 months occurred in 31 patients (26%) in the conventional group and 8 (12%) in the IMCU group (p = 0.026). However, after adjustment, conventional hospitalization was not significantly associated with the primary outcome (OR 2.25, 95% CI 0.90-6.09; p = 0.092). Institutionalized patients were more frequent in the conventional group (20% vs. 1.5%, p < 0.001). No significant differences were observed for other secondary outcomes, except for longer hospital stay in the IMCU group (p = 0.023) and higher post-hospitalization ADL/IADL scores (p = 0.026). CONCLUSION: IMCU management was not significantly associated with improved 12-month mortality or institutionalization, but was linked to better long-term autonomy. Standardized IMCU admission criteria, including baseline functional status, are needed.