The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting

Burns are one of the most common injuries sustained globally. Low- and middle-income countries (LMICs) are disproportionately affected by burn injury morbidity and mortality; African children have the highest burn mortality globally. In high-income countries, early surgical intervention has shown to improve survival. However, when applied to burn victims in LMICs, improved survival in the early excision cohort (≤5 d) was not seen. Therefore, we aimed to determine the magnitude of the effect of surgical intervention on burn injury survival.

A retrospective analysis of a prospectively collected data, utilizing the Kamuzu Central Hospital Burn Database from May 2011 to July 2019, was performed. Pediatric patients (≤12 y) were included. Patients were excluded if they underwent surgical intervention for nonacute burn care management. Bivariate analyses stratifying by type of surgical intervention was performed, comparing demographics, burn characteristics, surgical intervention, and patient mortality. Standardized estimates were adjusted using the inverse-probability of treatment weights to account for confounding. Weighted logistic regression modeling was performed to determine the odds of mortality based on if a patient underwent surgical intervention.

During the study, 2364 patients were seen at the Kamuzu Central Hospital, 1785 (75.5%) were children ≤12 y who met inclusion criteria. In the overall cohort, 342 (19.2%) underwent operations, including split-thickness skin graft (n = 196, 57.3%), debridement (n = 116, 33.9%), escharotomy (n = 19, 5.6%), and amputation (n = 1, 0.3%). The surgery cohort was older (4.2 ± 3.1 versus 3.1 ± 2.6 y, P < 0.001) with larger percent total body surface area burns (16%, interquartile range: 10-24 versus 13%, interquartile range: 8-20, P < 0.001) than those who did not have surgery. In the propensity score-weighted logistic regression predicting survival, patients undergoing surgery after burn injury had an increased odds of survival (odds ratio: 5.24, 95% confidence interval: 2.40-11.44, P = 0.003) when compared with patients not undergoing surgery.

In this propensity-weighted analysis, surgical intervention following burn injury increases the odds of survival by a factor of 5.24 when compared with patients not undergoing surgical intervention. Efforts to enhance burn infrastructure to deliver surgical care is imperative to attenuate burn mortality in resource-poor settings.