Optimal excision time for burn injuries of over 20% total body surface area: a retrospective review.

Abstract

Objective: While early excision of burn wounds is known to improve outcomes, the precise optimal timing within the early period remains unclear. A previous study by the authors suggests possible superiority in outcomes associated with immediate/expedited excision. This study aims to assess whether there is a difference in outcomes if initial excision is performed immediately (<24 hours), expedited (24-72 hours), or early (3-6 days) in adults with burns-related injuries of >20% total body surface area (TBSA).

Method: The authors performed a retrospective review of adults admitted to the Johns Hopkins Burn Center (Baltimore, US). The authors stratified the study groups based on pre-established definitions of time-to-excision: immediate (<24 hours); expedited (24-72 hours); and early (3-6 days). They assessed: blood-loss during the initial surgery; transfusion requirements; pain levels; daily analgesic requirements; complications; readmissions; length of stay (LoS) and mortality.

Results: The records of 1035 adult patients were reviewed, of which 99 patients with >20% TBSA required excision. Data showed 10 patients were in the immediate group, 63 in the expedited group, and 26 in the early group. Patients in the expedited group had significantly (p<0.05) greater blood loss, transfusion requirements, pain scores, analgesic requirements, readmissions, LoS and mortality than patients in the immediate and early groups.

Conclusion: The findings of this review suggest a bimodal optimal time-to-excision of 'immediately' or 'early'. The expedited group appeared to have worse outcomes. The immediate group had favourable outcomes, possibly due to the removal of the inflammatory nidus before systemic dysfunction took place, while the early group had favourable outcomes possibly due to the resolution and stabilisation of the patients' haemodynamic and inflammatory status. Based on the authors' data, immediate (<24 hours) and early (3-6 days) excision of burns are superior to expedited excision (24-72 hours). These results strongly argue in favour of a randomised, controlled trial to help define the optimal timing of burn wound excision.