Background Various surgical protocols suggest the need for chest cavity exploration during surgical stabilization of rib fractures (SSRF) in the presence of a hemothorax (HTX). The aim of this study is to determine the outcome of patients who underwent SSRF with blind HTX evacuation vs. HTX washout under visual inspection. Methods This is a retrospective analysis of prospectively collected data from the Chest Injury International Database (CIID), a data repository of the Chest Wall Injury Society (CWIS) contributing members. Two cohorts were created: group VATS (SSRF with Video-Assisted Thoracic Surgery (VATS)) and group IOPI (SSRF with blind intra-operative pleural irrigation (IOPI)). The primary endpoint was chest tube days after SSRF. Secondary endpoints were pneumonia, mortality, Intensive Care Unit length of stay (ICULOS), hospital length of stay (HLOS), 30-day readmission, and mechanical ventilation days. Results A total of 276 patients were included (VATS n = 129; IOPI n = 147). Chest tube duration was shorter in the VATS group (VATS: 0[0−2], IOPI: 3[2−5]; p ' 0.001), while hospital length of stay was shorter in the IOPI group (VATS: 10.5[7−15], IOPI 7[5−10]; p ' 0.001). Mechanical ventilation was more frequent in the VATS group (VATS: n = 83/129, IOPI: n = 21/147; p ' 0.001), whereas ventilation duration was longer in the IOPI group (VATS: 1[1], IOPI: 4[2−10]; p ' 0.001). Mortality (p = 0.417), pneumonia (p = 0.842), readmission (p = 0.107), and ICU length of stay among ICU-admitted patients (p = 0.953) did not differ between groups. After adjustment for injury severity and pulmonary contusion burden, VATS remained independently associated with shorter chest tube duration, whereas hemothorax evacuation technique was not independently associated with hospital or ICU length of stay. Conclusion The use of VATS during SSRF was associated with shorter chest tube duration, and this association remained significant after adjustment for injury severity and pulmonary contusion burden. However, broader clinical outcomes were comparable between techniques. Level of evidence Therapeutic / Care Management; Level IV.