The Impact of Initial Surgical Management on Outcome in Patients With Severe Burns: A 9-Year Retrospective Analysis
Authors: Zhu Wei , Shu Ziqin , Hu Gaozhong , Zhou Ling , Song Huapei 
Published: January 2022

Abstract
The aim is to investigate the prognostic value of the factors related to the initial surgical management of burn wounds in severely burned patients. A total of 189 severely burned adult patients who were admitted to our institute between January 2012 and December 2020 and met the inclusion criteria were recruited. Patients were divided into survival and nonsurvival groups. The patient data included sex, age, total burn surface area (TBSA), burn index, inhalation injury, mechanical ventilation, initial surgical management of the burn wound (including postinjury time before surgery, surgical duration, surgical area, intraoperative fluid replenishment, intraoperative blood loss, and intraoperative urine output), and duration in the burn intensive care unit (BICU). Independent samples t-tests, Mann–Whitney U-tests, and χ 2 tests were performed on these data. Those of which with statistically significant differences were subjected to univariate and multivariate Cox regression analyses to identify independent risk factors affecting the prognosis of severely burned patients. Receiver operating characteristic curves were plotted, and the area under the curve (AUC) and optimal cutoff value were calculated. Patients were divided into two groups, according to the optimal cutoff value of the independent risk factors. The TBSA, surgical area, and survival rates of the two groups during hospitalization were analyzed. The survival group (146 patients) and the nonsurvival group (43 patients) differed significantly in TBSA, burn index, inhalation injury, mechanical ventilation, initial surgical area, intraoperative fluid replenishment, intraoperative blood loss, and duration in the BICU (P &lt; .05). Univariate Cox regression analysis showed that TBSA, burn index, mechanical ventilation, initial surgical area, intraoperative fluid replenishment, and intraoperative blood loss were risk factors for death in severely burned patients (P &lt; .05). Multivariate Cox regression analysis showed that the burn index and intraoperative blood loss were independent risk factors for death in severely burned patients (P &lt; .05). When the intraoperative blood loss during the initial surgical management of burn wounds was used to predict death in 189 severely burned patients, the AUC was 0.637 (95% confidence interval: 0.545–0.730, P = .006), and the optimal cutoff for intraoperative blood loss was 750 ml. Kaplan–Meier survival analysis showed that the prognosis of the group with intraoperative blood loss ≤750 ml was better than that of the group with intraoperative blood loss &gt;750 ml (P = .008). Meanwhile, the TBSA and surgical area in the group with intraoperative blood loss ≤750 ml were significantly lower than that of the group with intraoperative blood loss &gt;750 ml (P &lt; .05). The burn index and intraoperative blood loss during the initial surgical management of burn wounds are independent risk factors affecting the outcome of severely burned patients with good predictive values. During surgery, hemostatic and anesthetic strategies should be adopted to reduce bleeding, and the bleeding volume should be controlled within 750 ml to improve the outcome.