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Anaya M, Feinberg GJ, Lopardo TL, Kheirbek T. Disparity in Risk of Readmission in Adult Burn Patients: Analysis of a Nationwide Readmission Database. J Surg Res 2024; 301:534-539. [PMID: 39047385 DOI: 10.1016/j.jss.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/18/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Burn injuries remain a significant cause of disability, impacting long term quality-of-life and imposing large costs on our health systems. Readmission is a metric of quality and an important contributor to this economic burden. The association of socioeconomic and insurance status with burn readmission is not well established. The aim of our study is to develop a predictive risk model of factors associated with readmission after burns. METHODS Using the Healthcare Cost and Utilization Project's 2018 Nationwide Readmission Database, we identified patients ≥18 y of age with burns admitted between January and October 2018. We excluded patients who died during index admission. Our primary outcome was readmission within 60 d postdischarge. We performed a Lasso regression analysis with adaptive selection to generate a predictive model with least deviance using patients' demographics and socioeconomic status, burn location and severity, past medical history, and hospital characteristics. Weighted multiple logistic regression was performed to obtain population estimates of adjusted odds ratios (ORs) of each element in the model. RESULTS Our cohort included 11,380 burn patients. Of those, 1625 (14.3%) were readmitted and 67% were males. Readmitted patients were older (55 ± 17 versus 49 ± 18, P = 0.0001). Weighted logistic regression for the selected model showed higher odds of readmission for patients with lowest income quartile (OR: 1.19, 95% confidence interval [CI]: 1.04-1.36), Medicare or Medicaid insurance (OR: 1.35, 95% CI: 1.17-1.55), history of psychiatric illness (OR:1.19, 95% CI: 1.02-1.39), diabetes (OR: 1.46, 95% CI: 1.25-1.69), chronic kidney disease (OR: 1.66, 95% CI: 1.30-2.11), chronic obstructive pulmonary disease (OR: 1.55, 95% CI:1.26-1.89), and alcohol use disorder (OR: 1.33, 95% CI: 1.13-1.58). Third degree burns and foot burns had higher OR of readmission (OR: 1.21, 95% CI: 1.38-1.98 and 1.66, 95% CI: 1.02-1.45, respectively), while face and hand burns had lower OR of readmission (OR: 0.77, 95% CI: 0.66-0.90 and 0.84, 95% CI: 0.72-0.98, respectively). CONCLUSIONS Burn readmissions are multifactorial and directly related to the patient's comorbidities, including markers that reflect barriers to care such as socioeconomic characteristics, as well as the anatomical location of burn injuries. Early identification of these high-risk patients may aid in early intervention, resource allocation, and outreach program development in an attempt to reduce readmission rates and improve outcomes. Future prospective validation of these risk factors is warranted.
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Affiliation(s)
- Melanie Anaya
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Griffin J Feinberg
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Thomas L Lopardo
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Tareq Kheirbek
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island.
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Knoedler S, Matar DY, Knoedler L, Obed D, Haug V, Gorski SM, Kim BS, Kauke-Navarro M, Kneser U, Panayi AC, Orgill DP, Hundeshagen G. Association of age with perioperative morbidity among patients undergoing surgical management of minor burns. Front Surg 2023; 10:1131293. [PMID: 36923377 PMCID: PMC10008887 DOI: 10.3389/fsurg.2023.1131293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. Methods We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. Results We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n = 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p = 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p = 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. Discussion In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Doha Obed
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sabina M Gorski
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Melquíades da Rocha BDF, Bochnia MF, Ioris RA, Damin R, de Araujo Santos Nigro MV, Nisihara RM. The impact of social isolation by COVID-19 on the epidemiological and clinical profiles of the burn patients. A retrospective study. Burns 2022; 48:976-983. [PMID: 35361496 PMCID: PMC8882480 DOI: 10.1016/j.burns.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims. OBJECTIVE Evaluate the changes in the epidemiological profile of patients with burns that resulted in hospitalization during the social isolation period due to the COVID-19 pandemic, comparing with the same period in the previous year. METHODS The medical records of burn patients who were hospitalized in our Burn Center during the local confinement period (March 18th to August 31st, 2020) and during the same period in 2019 were analyzed. Data on demographic, clinical and hospitalization aspects were studied. RESULTS 470 patients were evaluated. In the pediatric population, a significant increase in the number of cases up to 2 years old (P = 0.0003), median of %TBSA (P = 0.037), full-thickness burns (P < 0.0001), involvement of hands (P = 0.024), debridement (P = 0.046) and grafting (P = 0.032) procedures, and higher scores of severity (P < 0.0001) were noted. In the adult population, it was only observed an increase in the burn-hospitalization interval (P = 0.029). CONCLUSION The pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.
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Affiliation(s)
| | - Mateus Franzoni Bochnia
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil. Rua Padre Anchieta, 2770, 80730-000 Curitiba, Brazil
| | - Rafael Augusto Ioris
- Plastic Surgery Department and Burn Center, Hospital Universitário Evangélico Mackenzie, Alameda Augusto Stellfeld, 1908, 80730-150 Curitiba, Brazil
| | - Renata Damin
- Plastic Surgery Department and Burn Center, Hospital Universitário Evangélico Mackenzie, Alameda Augusto Stellfeld, 1908, 80730-150 Curitiba, Brazil
| | | | - Renato Mitsunori Nisihara
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil. Rua Padre Anchieta, 2770, 80730-000 Curitiba, Brazil,Correspondence to: Rua Padre Anchieta, 2770, 80730-000 Curitiba, Paraná, Brazil
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Gurbuz K, Demir M. Comparison of work- and non-work-related lower extremity burn injuries: a retrospective analysis. J Burn Care Res 2022; 43:1337-1342. [PMID: 35290468 DOI: 10.1093/jbcr/irac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Lower extremity burn injuries are among the most affected anatomical regions in hospitalized burn patients. Our objective was to compare burn patients with work-related isolated lower extremity burn injuries (w-ILEBI) and patients with non-work-related isolated lower extremity burn injuries (nw-ILEBI). Sixty-four (15.7%) of 407 patients (16-92 years) were in the w-ILEBI cohort. The most extensive burn wounds were among patients in the fire-flame group with a median total body surface area percent (%TBSA) of 27.0 (IQR= 11.0-45.0%). While 50 (76.9%) patients in the electrical group had full-thickness burns, 99 (60%) of the cases in the scald group had superficial partial-thickness burns. Blood and wound sample cultures were positive in 42 (29.4%) patients in the fire-flame group. Approximately one-third of patients in the fire-flame/electrical group required escharotomy/fasciotomy procedures, only one (0.6%) case in the scald group, and none in the chemical/contact groups. Thirty-three (51%) of the patients in the electrical group underwent skin grafting, but fourteen (21.5%) required amputations. The highest mortality was detected in 27 (18.9%) patients in the fire-flame group. This study revealed several differences in clinical characteristics of isolated lower extremity burn injuries (ILEBI): burn mechanism and depth, %TBSA, infection, surgery requirements, laterality, and mortality. Within the scope of occupational health and safety measures, protective clothing and increased workplace and safety training for employers/employees should be implemented.
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Affiliation(s)
- Kayhan Gurbuz
- University of Health Sciences, Adana Faculty of Medicine, Department of General Surgery, Burn Center, Adana, Turkey
| | - Mete Demir
- University of Health Sciences, Adana Faculty of Medicine, Department of General Surgery, Burn Center, Adana, Turkey
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Rotman S, Lapaine P, Rehou S, Jeschke MG, Shahrokhi S. Comparison of clinical outcomes of lower extremity burns in diabetic and non-diabetic patients: a retrospective analysis. J Burn Care Res 2021; 43:93-97. [PMID: 34329452 DOI: 10.1093/jbcr/irab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diabetes mellitus is an increasingly prevalent chronic disease that leads to long-term health consequences. Some long-term clinical sequelae of diabetes include coronary artery disease, peripheral vascular disease, peripheral neuropathy, and impaired wound healing. These can increase hospital stay and complications such as wound infections and amputations among patients with lower extremity burns. A retrospective analysis was performed of all isolated lower extremity burns from a single tertiary burn care centre from 2006-2017. Patients were stratified by diabetic status and the incidence of lower extremity amputations was the primary outcome. Multivariable regression was used to model the association between diabetes and amputations, adjusting for patient and injury characteristics. A total of 198 patients were identified as meeting inclusion criteria, 160 were non-diabetic and 38 were diabetic. Age was significantly different between non-diabetic and diabetic patients; mean age was 46 ± 18 years versus 62 ± 17 years (p<0.0001). Length of stay was also significantly different, median length of stay was 11 (IQR 7-15) versus 18 (IQR 12-24) (p<0.001), with diabetic patients staying longer. There was a significantly greater proportion of diabetic patients that had an amputation (control 4% versus diabetic 29%; p<0.0001). After adjustment for patient and injury characteristics, there was a significant association between diabetes and amputation (p=0.002). Among patients with isolated lower extremity burns, those with a pre-existing condition of diabetes had a longer hospitalization and increased amputations, despite similar size of burn. Diabetes is an important risk factor to acknowledge in patients with these injuries to optimize care.
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Affiliation(s)
- Sydney Rotman
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Pierre Lapaine
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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