From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University; Regional Burn Center, Santa Clara Valley Medical Center; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California; Southern California Regional Burn Center at Los Angeles County and University of Southern California; and Division of Trauma, Burn, and Critical Care Surgery, University of Washington.
Plast Reconstr Surg. 2021 Dec 1;148(6):1001e-1006e. doi: 10.1097/PRS.0000000000008573.
Acute burn care involves multiple types of physicians. Plastic surgery offers the full spectrum of acute burn care and reconstructive surgery. The authors hypothesize that access to plastic surgery will be associated with improved inpatient outcomes in the treatment of acute burns.
Acute burn encounters with known percentage total body surface area were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Edition, codes. Plastic surgery volume per facility was determined based on procedure codes for flaps, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators, and mortality. Regression models included the following variables: age, percentage total body surface area, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status of hospital.
The weighted sample included 99,510 burn admissions with a mean percentage total body surface area of 15.5 percent. The weighted median plastic surgery volume by facility was 245 cases per year. Compared with the lowest quartile, the upper three quartiles of plastic surgery volume were associated with increased likelihood of undergoing flap procedures (p < 0.03). The top quartile of plastic surgery volume was also associated with decreased odds of patient safety indicator events (p < 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death.
Burn encounters treated at high-volume plastic surgery facilities were more likely to undergo flap operations. High-volume plastic surgery centers were also associated with a lower likelihood of inpatient complications. Therefore, where feasible, acute burn patients should be triaged to high-volume centers.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
急性烧伤治疗涉及多种类型的医生。整形手术提供了急性烧伤治疗和重建手术的全部范围。作者假设，获得整形手术将与改善急性烧伤患者的住院治疗结果相关。
根据国际疾病分类第 9 版代码，从 2012 年至 2014 年从国家住院患者样本中提取已知总体表面积百分比的急性烧伤就诊。根据皮瓣、乳房重建和复杂手部重建的手术代码确定每个设施的整形手术量。结果包括接受皮瓣的可能性、患者安全指标和死亡率。回归模型包括以下变量：年龄、总体表面积百分比、性别、吸入性损伤、合并症、医院规模以及医院的城市/教学地位。
加权样本包括 99510 例烧伤住院患者，平均总体表面积百分比为 15.5%。加权中位数设施整形手术量为每年 245 例。与最低四分位数相比，上三个四分位数的整形手术量与接受皮瓣手术的可能性增加相关（p < 0.03）。整形手术量最高的四分位数也与患者安全指标事件的可能性降低相关（p < 0.001）。整形手术设施量与住院死亡可能性的差异无显著相关性。
在高容量整形手术设施接受治疗的烧伤就诊患者更有可能接受皮瓣手术。高容量整形手术中心也与住院并发症的可能性降低相关。因此，在可行的情况下，急性烧伤患者应分诊至高容量中心。
临床问题/证据水平：治疗，III 级。
