Lim Jolene, Liew Sarah, Chan Hayley, Jackson Teresa, Burrows Sally, Edgar Dale W, Wood Fiona M
School of Medicine and Dentistry, University of Western Australia, Australia.
Fiona Wood Foundation, Australia.
Burns. 2014 Mar;40(2):235-40. doi: 10.1016/j.burns.2013.06.005. Epub 2013 Jul 19.
Acute wound closure surgery improves outcomes, after burn particularly mortality, but also imposes physiological stress on the patient. The duration of surgery is associated with adverse outcomes in other populations. This study aimed to examine if extended acute burn surgery duration was associated with poorer in-hospital outcomes.
This retrospective cohort study included adult burn patients who required a single wound closure surgery at Royal Perth Hospital between 2004 and 2011. Multivariable regression analyses were used to assess the influence of patient and injury factors on surgery duration and length of stay (LOS).
Surgery duration independently increased LOS (incidence rate ratio [IRR]=1.004, p<0.001). This translates to a predicted 13% increase in LOS for a 30min increase in surgery 'knife to skin' time. Total body surface area (TBSA) was identified as a significant predictor of surgery duration (IRR=1.047, p<0.001), estimating that a 10% TBSA increase results in a 59% increase in surgery duration.
The results show that surgery duration is associated with LOS after adjusting for size of burn and other factors. The study justifies the need to explore strategies to reduce acute burn surgery duration.
急性伤口闭合手术可改善烧伤后的治疗效果，尤其是降低死亡率，但也会给患者带来生理压力。手术时间与其他人群的不良预后相关。本研究旨在探讨急性烧伤手术时间延长是否与住院期间较差的治疗效果相关。
这项回顾性队列研究纳入了2004年至2011年间在皇家珀斯医院接受单次伤口闭合手术的成年烧伤患者。采用多变量回归分析评估患者和损伤因素对手术时间和住院时间（LOS）的影响。
手术时间独立增加住院时间（发病率比值[IRR]=1.004，p<0.001）。这意味着手术“刀到皮肤”时间每增加30分钟，住院时间预计增加13%。全身表面积（TBSA）被确定为手术时间的重要预测因素（IRR=1.047，p<0.001），估计TBSA增加10%会导致手术时间增加59%。
结果表明，在调整烧伤面积和其他因素后，手术时间与住院时间相关。该研究证明有必要探索缩短急性烧伤手术时间的策略。
