Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa.
Brown University School of Public Health, Providence, RI.
Burns. 2021 Jun;47(4):922-929. doi: 10.1016/j.burns.2020.09.002. Epub 2020 Oct 3.
Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality.
All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and χ2 test or Fisher's exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders.
During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)].
This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.
早期手术可以改善烧伤患者的预后，但在资源有限的环境中（LRS），通常无法进行早期手术，而更保守的治疗方法较为普遍。本研究旨在分析与手术延迟相关的因素，并探讨其对住院死亡率的影响。
本研究为回顾性研究，纳入了 2016 年至 2019 年期间在南非彼得马里茨堡烧伤科接受手术治疗的所有烧伤患者。早期手术定义为伤后 7 天内接受手术的患者。对人群进行描述性分析，并使用 t 检验、卡方检验或 Fisher 确切检验（视情况而定）比较组间差异。多变量逻辑回归用于分析手术延迟对住院死亡率的影响，调整混杂因素后进行分析。
研究期间，共有 620 例烧伤患者接受了手术治疗。其中，16%的患者接受了早期手术。与晚期手术组相比，早期手术组的中位年龄和 TBSA 分别为 11 岁（3-35 岁）和 12.0%（5-22%），而晚期手术组分别为 7 岁（2-32 岁）和 6.0%（3-13%）（p=0.45，p<0.001）。在逻辑回归中，女性（优势比[OR]：3.30，95%置信区间[CI]：1.47-7.41]）、TBSA%（OR：1.09，95%CI：1.05-1.12）和 FTB（OR：3.21，95%CI：1.43-7.18）与住院死亡率相关，而早期手术与住院死亡率无关（OR：1.74，95%CI：0.76-3.98）。
本研究发现早期手术与住院死亡率无关。住院死亡率的独立预测因素为女性、全层烧伤和更大的烧伤面积。未来的研究应探讨 LRS 的烧伤治疗能力是否会影响早期切除与结局之间的关联。
