48 Genital Burns Are Associated with Worse Psychosocial and Physical Outcomes
Authors: Shah Suhaib , Segura Carolina , Ramgopal Yash , Richter Christopher G , Krishna Sunskruthi , Haseem Maria , Nicot-Cartsonis Mathilda , Golovko Georgiy , Wolf Steven E , Song Juquan , ayadi Amina E I 
Published: April 2024

Abstract

Introduction
Genital burns (GB) represent a specialized subset of injuries with a profound impact on quality of life and psychosexual health. Analysis of GB is notably sparse in the current literature. This study aims to address GB short and long-term outcomes, psychosocial outcomes, and outcome variations based on the gender. We compared GB with burns in general, controlling for the extent and severity of injury.

Methods
Using a federated network of real-world data, GB (n = 3,508) and all burn (AB) (n = 358,136) cohorts were created using specific ICD-10 codes. Cohorts were balanced using age at index, gender, race, and ethnicity. Covariates were defined by a time window up to 1 day before burn. The following outcomes were selected for short-term analysis (1 month): deceased, PTSD, depression, anxiety, ICU admit, skin graft loss, sepsis, pneumonia, respiratory failure, acute renal failure, and ventilator use. Long-term analysis (5 years) was performed for the following outcomes: deceased, PTSD, depression, anxiety, joint pain, chronic neuropathic pain, and pruritus. For the gender comparisons, catheter infection, UTI, and dysuria were also investigated. We ran measures of association cohort analyses to compare outcomes with risk ratios (RR) and 95% confidence intervals (95% CI).
GB (balanced: n = 3,277) was compared to AB (balanced: n = 3,277). To focus on isolated area burns, we compared non-severe (TBSA &lt; 20%) GB (n = 1,918) to non-severe AB (n = 101,446) (balanced cohorts: n = 1,896 each). Lastly, non-severe male GB (n = 2,353) was compared to non-severe female GB (n = 1,183) (balanced cohorts n = 649 each).

Results
When comparing all GB and all AB patients a substantial array of differences emerged: In non-severe burns, GB patients experienced significantly higher RRs for death (RR = 2.36, 95% CI: 1.171-4.77), anxiety (RR = 2.3, 95% CI: 1.2-4.41), hospitalization (RR =1.58, 95% CI: 1.301-1.919), ventilator use (RR = 2.087, 95% CI: 1.275-3.417), and pruritus (RR = 1.969, 95% CI:1.08-3.587) in the short-term, and higher rates of pruritus (RR = 1.881, 95% CI: 1.36-2.603) and neuropathic pain (RR = 1.827, 95% CI: 1.157-2.885) in the long-term.
Gender-based GB comparisons showed significant short-term differences including an increased rate of anxiety (RR = 0.314, 95% CI: 0.154-0.639) in females. Long-term outcomes showed a higher rate of anxiety (RR = 0.722, 95% CI: 0.523-0.998), dysuria (RR = 0.561, 95% CI: 0.378-0.831), and UTI (RR = 0.394, 95% CI: 0.277-0.56) in female patients.

Conclusions
Genital burn patients have higher risks of developing certain short- and long-term outcomes, some of these being more pronounced based on gender.

Applicability of Research to Practice
Increased rates of death, anxiety, hospitalization, pruritus, and neuropathic pain amongst genital burn patients underlies the need for nuanced clinical and psychosocial approaches, specifically tailored to address the unique challenges and requirements associated with genital burns.