Intercostal nerve cryoablation in surgical stabilization of rib fractures: Does the benefit depend upon patient acuity?

Abstract

Intercostal nerve cryoablation (IC) is commonly performed during surgical stabilization of rib fractures (SSRF) to provide analgesic benefit; however, evidence supporting its efficacy is limited, and long-term outcomes are not well described. We performed a retrospective cohort study of consecutive patients who underwent SSRF for acute indications at a Level I trauma center between 2016 and 2025. During SSRF, IC was performed at surgeon discretion. Patients were excluded if they received any operation besides SSRF during admission. Outcomes were compared based on treatment with IC and further stratified by mechanical ventilation status. The primary outcome was opioid exposure, evaluated in the nonventilated cohort using multivariable linear regression. Long-term follow-up outcomes were reported. One hundred thirty-four patients met the inclusion criteria. In adjusted regression analysis of nonventilated patients (n=104), IC demonstrated no clear reduction in average daily opioid exposure (-10.4 MME/d, 95% CI: -32.7 to 11.9, p=0.357). In ventilated patients (n=30), IC was associated with reductions in duration of mechanical ventilation (median 1.8 vs. 5.3 d, p=0.040) and pneumonia (10% vs. 50%, p=0.049). After discharge, IC was associated with more frequent referral to pain management specialty care for intercostal neuralgia (20% vs. 4.5%, p=0.018). These data do not support the routine use of IC during SSRF for nonventilated patients, although selective IC may benefit ventilated patients. When surgeons consider offering IC, the risk of intercostal neuralgia should be weighed against anticipated benefits. Future studies should control for ventilator status, as it may greatly influence the treatment effect. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.). Therapeutic/Care Management; Level IV.