Location, Payer Type, and Gender as Drivers of Burn Scar Reconstruction Utilization: A Burn Model Systems National Database Study.

Abstract

Background: There are demographic and socioeconomic disparities in physical and psychosocial outcomes after burn injury. Here, we assess the demographic and geographic variation in utilization of burn scar reconstruction to assess if such barriers to these procedures may be contributing to disparities in outcomes.

Methods: We performed a retrospective cohort study using prospectively collected data from adults enrolled in the Burn Model System National Database between 2015 and 2022. Undergoing burn scar reconstruction, defined as surgery for burn scars or laser scar revision, by 24 months after discharge was compared across age group (18-64 vs 65+ years), gender, race/ethnicity, payer type, and enrollment site. Multiple logistic regression was used to assess use of burn scar reconstruction by demographic characteristics while adjusting for presence of range of motion deficits at discharge, hand burn, head/neck burn, and upper arm/shoulder burn.

Results: In the unadjusted analysis (N = 836), burn scar reconstruction use by 24 months differed by age group (<0.001), race/ethnicity ( P = 0.014), payer type ( P < 0.001), and enrollment site ( P < 0.001). By multiple logistic regression (n = 717), burn scar reconstruction was associated with female sex (odds ratio [OR] 1.89, P = 0.002), workers' compensation (OR 3.41, P < 0.001), enrollment at site 1 or site 2 (OR 6.02, P < 0.001; OR 4.09, P < 0.001), hand burns (OR 2.35, P < 0.001), and upper arm/shoulder burns (OR 2.34, <0.001).

Conclusions: Location, payer type, and gender were primary drivers of burn scar reconstruction use after adjusting for burn characteristics. Geographic variability in burn scar reconstruction use may reflect less dependence on surgery to achieve favorable functional outcomes; however, these differences may represent barriers requiring further evaluation.