Background
The optimal timing for burn surgery is an ongoing debate, with early intervention showing potential benefits but lacking conclusive evidence in a recent review. Large, high-quality studies are needed to determine the best approach. This study examined the impact of early (≤7 days) versus late (>7 days) burn surgery on long-term surgical and functional outcomes.
Methods
This retrospective cohort study used data from adult patients from the Burns Clinical Data Registry of Western Australia from 2012-2022. Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Lower Limb Functional Index (LLFI) surveys measured functional impairment and recovery at 4-6 week, 3 month and 6 month intervals post burn. Unadjusted descriptives and those with single surgeries for upper limb burns have been studied to inform the design of multivariate regression analyses and mixed-effect regression modelling.
Results
Preliminary analysis of those who had one surgery for upper limb burns was conducted (n=1548 of 3245 total cohort). Over two-thirds of these patients had surgery within 7 days. The mean Total Burn Surface Area (TBSA) was 3.6%, the mean time to surgery was 6.3 days. QuickDASH scores revealed improvement of function without significant differences between the early and late surgery group at intervals. These results are indicative of a floor affect associated with the early post-operative recovery of patients with small TBSA upper limb burns. Exploration of these results with adjustment for severity markers and known confounders is progressing.
Discussion
Our large cohort study with longitudinal assessments will provide important evidence for this ongoing debate.