Department of Surgery, University of North Carolina School of Medicine, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
World J Surg. 2023 Dec;47(12):3093-3098. doi: 10.1007/s00268-023-07218-8. Epub 2023 Oct 10.
Defining the optimal timing of operative intervention for pediatric burn patients in a resource-limited environment is challenging. We sought to characterize the association between mortality and the timing of operative intervention at a burn center in Lilongwe, Malawi.
This is a retrospective analysis of burn patients (<18 years old) presenting to Kamuzu Central Hospital from 2011 to 2022. We compared patients who underwent excision and/or burn grafting based on the timing of the operation. We used logistic regression modeling to estimate the adjusted odds ratio of death based on the timing of surgery.
We included 2502 patients with a median age of 3 years (IQR 1-5) and a male preponderance (56.8%). 411 patients (16.4%) had surgery with a median time to surgery of 18 days (IQR 8-34). The crude mortality rate among all patients was 17.0% and 9.1% among the operative cohort. The odds ratio of mortality for patients undergoing surgery within 3 days from presentation was 5.00 (95% CI 2.19, 11.44) after adjusting for age, sex, % total burn surface area (TBSA), and flame burn. The risk was highest for the youngest patients.
Children who underwent burn excision and/or grafting in the first 3 days of hospitalization had a much higher risk of death than patients undergoing surgical intervention later. Delaying operative intervention till >72 h for pediatric patients, especially those under 5 years old, may confer a survival advantage. More investment is needed in early resuscitation and monitoring for this patient population.
在资源有限的环境下，确定儿科烧伤患者手术干预的最佳时机具有挑战性。我们旨在探讨马拉维利隆圭卡姆祖中央医院烧伤中心患者死亡率与手术时机的相关性。
这是一项对 2011 年至 2022 年期间到卡姆祖中央医院就诊的<18 岁烧伤患者的回顾性分析。我们比较了根据手术时间进行切除和/或烧伤植皮的患者。我们使用逻辑回归模型，根据手术时间来估计死亡的调整后比值比。
共纳入 2502 例患者，中位年龄为 3 岁（IQR 1-5），男性居多（56.8%）。411 例（16.4%）患者接受了手术，手术时间中位数为 18 天（IQR 8-34）。所有患者的粗死亡率为 17.0%，手术组为 9.1%。调整年龄、性别、总烧伤面积（TBSA）%和火焰烧伤后，就诊后 3 天内行手术患者的死亡比值比为 5.00（95%CI 2.19，11.44）。风险最高的是年龄最小的患者。
与就诊后>72 小时行手术干预的患者相比，住院后前 3 天内行烧伤切除和/或植皮的患儿死亡风险高得多。对于儿科患者，尤其是 5 岁以下的患者，延迟手术干预至>72 小时可能带来生存优势。该患者群体需要更多的早期复苏和监测投资。
