Objective To compare the efficacy of operative and non-operative methods in the treatment of severe thoracic trauma in Tibetan Plateau.Methods A retrospective case-control study was conducted to analyze 286 patients with severe thoracic trauma admitted to the Shigatse People's Hospital from August 2016 to October 2018.There were 206 males and 80 females,aged 13-71 years [(34.3 ±11.6) years].The duration from injury to hospital ranged from 2 to 49 hours [(22.8 ± 8.3) hours].The causes of injury including fall from height in 109 patients,traffic injury in 98,crush injury in 32,blunt injury in 29,cattle head injury in 9,knife stab injury in 6 and other causes in 3.The injury severity score (ISS) varied from 16 to 48 points on admission [(24.2 ± 8.8) points].A total of 159 patients underwent operation (Operation group) and 127 patients underwent non-operative treatment (Non-operation group).The ISS score was (25.2 ± 8.3)points in Operation group and (23.7 ±7.9)points in Non-operation group.The length of hospital stay,intensive care unit (ICU) care time,complication rate and mortality were recorded in two groups.The correlation of ISS and age with mortality was investigated.Results The length of hospital stay was (12.2 ± 3.8) days in the Operation group and (19.7 ± 5.8) days in the Non-operation group (P ＜ 0.05).In the Operation group,27 patients were admitted to the ICU and stayed for (4.7 ± 1.3)days,and in the Non-operation group 33 patients were admitted to the ICU and stayed for (11.7 ± 3.2) days (P ＜ 0.05).The complication rate was 17.6％ in the Operation group and 31.5％ in the Non-operation group (P ＜0.05).Two patients died in the Operation group,with the mortality rate of 1.3％;six patients died in the Non-operation group,with the mortality rate of 4.7％,with no statistical difference (P ＞ 0.05).There were statistically significant differences in the age of death between the Operation group and the Non-operation group (P ＜ 0.05).The differences in the ISS score and age between the survival and death patients within the two groups were statistically significant (P ＜0.05).Logistic regression analysis showed age (OR =1.090,95％ CI 1.002-1.186) and ISS (OR =1.058,95％ CI 1.027-1.090) were slqnificantly related to mortality.Conclusions For severe thoracic trauma in Tibetan Plateau,operative treatment can shorten the length of hospital stay and ICU care time and reduce the incidence of complications.The mortality ratio of the two groups has no significant difference.Age and ISS may be the high risk factors for death of severe thoracic trauma patients.