Factors impacting time to surgery and the effect on in-hospital mortality

• Published in: Burns Vol. 47; no. 4; pp. 922 - 929
• Main Authors: Allorto, Nikki, Rencken, Camerin A., Wall, Shelley, Pompermaier, Laura
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2021
• Subjects: Burn injury; Patient outcomes; South Africa; Time to surgery; South Africa; Time to surgery; Burn injury; Patient outcomes
• ISSN: 0305-4179; 1879-1409; 1879-1409
• DOI: 10.1016/j.burns.2020.09.002

•TBSA% and inhalation injury were associated with having early surgery.•Patients having early surgery had higher in-hospital death.•TBSA%, FTB, and female sex were independently associated with in-hospital death.•Early surgery was not independently associated with in-hospital death. Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and χ2 test or Fisher’s exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3–35) and 12.0% (5–22) compared to 7 years (2–32) and 6.0% (3–13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47–7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05–1.12)], and FTB [aOR: 3.21 (95% CI: 1.43–7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76–3.98)]. This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.