Photo Credit: Wongsakorn Napaeng

Predictors of burn surgery timing include total body surface area burned, older age, psychiatric medical history, and flame, flash, and contact burns.

Burn severity highly influences the timing of surgery in acute burn care, according to findings from a multicenter registry-based cohort study published in Burns Open.

The study examined the timing of surgery for patients with moderate to severe burns at burn centers. Surgical care within 7 days of a burn was considered early surgery, while later surgery occurred beyond 7 days.

Prior research found that the mean timing of surgery is 14.7 days after a burn in specialized burn care between 1995 and 2011 in admitted burn patients, the study investigators noted. These findings support the view that burn surgery is often performed relatively late; however, it is unclear whether this remains the case in daily clinical practice.

For this study, the researchers analyzed data from three burn centers for 3,291 adults who underwent surgery for a burn injury between 2009 and 2021.

Timing of Surgery & Related Predictors

The median time to the first surgical intervention was 14 days. A fifth of patients received surgery within 7 days.

“There appeared to be a significant but small increase in the timing of surgery in the 13-year study period,” the researchers reported. “In general, patients with more severe burns were more likely to undergo early surgery, which is reflected in the poorer clinical outcomes observed in this group.”

In addition to larger total body surface area burned, other predictors of early surgery included age (≥65 years), a psychiatric medical history, and flame, flash, and contact burns compared with scald burns.

Link to Burn Severity

In exploratory analyses, researchers identified a small but significant increase in the timing of surgery between 2014 and 2021, from a median of 12 days to 16 days.

“A potential explanation for this could be the increase in outpatient treatments in recent years,” researchers wrote. “Patients with minor burns may present at the outpatient clinic with a delay.”

This potential explanation is supported by the finding that patients in the late surgery group had a longer time from injury to admission, they noted.

The findings suggest a nuanced approach to burn surgery, with burn severity significantly influencing timing.

“Further research is needed, focusing on patient-centered outcomes and international perspectives,” study investigators wrote.