Four hundred and three patients with multiple rib fractures were randomized to either the early rib fixation group (n=201) or the delayed rib fixation group (n=202). The primary outcomes of interest were days in the intensive care unit (ICU), length of hospital stay, ventilation days, hospitalization cost, operation time, operative blood loss, and 30-day all-cause mortality. Secondary outcomes of interest included inflammatory cytokine levels (TNF-a and IL-6), infection index levels (C-reactive protein, procalcitonin, and white blood cell count), and postoperative complications. ICU days, length of stay, hospitalization costs, ventilation days, TNF-a, IL-6. CRP, WBC, surgical site infection, pulmonary infection, and atelectasis were all significantly better in the early rib fixation group.