Predictors of Reconstructive Surgery Among Burn Patients

Introduction: Burns are a major source of morbidity and mortality within the realm of trauma.  After surviving the initial injury, reconstructive surgery (RS), such as skin grafts, dermal regenerative grafts, and flaps are common procedures performed to repair extensive burn wounds.  In this study, predictors for the use reconstruction in burn injuries were evaluated.

Methods: The National Burn Repository (NBR) 2002-2011 was reviewed to identify patients with thermal injury.  Patients who expired during hospitalization were excluded.  Patients were divided into two groups based on the use (or not) of RS, identified using ICD-9 procedure codes.  The two groups were compared in terms of patient and injury characteristics using bivariate and logistic regression analysis.  Data for adults and children (<18 years old) were analyzed separately.

Results: A total of 119,341 patients, 34% children and 66% adults, were identified.  Overall, 36% of the children and 46% of the adults underwent at least one RS.  In both adults and children, rate of RS was higher among diabetic, smoking, obese patients with burn injuries of the neck and lower extremities.  The rates were lower in Asians, and those with burn injuries of the head.  Predictably, in both age groups, the rate of RS increased with %TBSA burn and age.  In both age groups, logistic regression showed significant associations between African-American race (OR compared to White race=children: 1.25, adults: 1.26), lower extremity (OR=1.3 and 1.5) and neck injury (OR=1.1 and 1.5), contact with hot objects (OR=1.9 and 1.7), age, and % TBSA burn with higher probability of RS.  In adults, diabetes (OR=1.1), smoking (OR=1.05), and obesity (OR=1.5) were also predictive of higher rates of RS.  Compared to adults, children also had a 10-15% lower incidence of RS with burns less than 20% but the incidence increased to match adults with greater than 30% TBSA burns.

Conclusion: The largest dataset for burns is used in this study to predict the need for surgery based on patient demographics.  Alsthough %TBSA burn and age are important, the NBR also identifies race, location of burn, diabetes, smoking, and obesity as significant risk factors for requiring reconstructive surgery.  Further studies are warranted to better characterize why these risk factors increase the necessity of reconstructive surgery.