The Association Between Burn Unit Census and Operative Intervention in a Resource-Limited Setting

Area of Science:

• Global Health
• Surgical Outcomes
• Burn Care Management

Background:

• The relationship between hospital patient volume and patient outcomes in burn care is not well understood, especially in resource-limited settings.
• High demand for burn care services in these areas can exceed available capacity, impacting treatment quality.

Purpose of the Study:

• To investigate the association between patient volume and the utilization of operative interventions for burn patients.
• To analyze the impact of patient census on the timing of surgical procedures in a tertiary burn unit in Malawi.

Main Methods:

• Retrospective analysis of 2484 burn patients admitted to Kamuzu Central Hospital, Malawi (2011-2019).
• Patient census categorized as low (≤15), medium (16-29), and high (≥30 patients).
• Statistical analysis to determine the association between census levels and operative intervention rates and time to operation.

Main Results:

• Higher patient census (medium and high) was associated with a significantly reduced likelihood of undergoing surgery (RR 0.79 and 0.65, respectively).
• Increased patient volume correlated with a longer time to operation, with a high census associated with a mean delay of 28.3 days compared to 17.2 days at low census.
• Daily burn unit census exhibited significant seasonal variation.

Conclusions:

• Increasing patient volume in resource-limited burn units significantly decreases operative intervention rates and increases delays in surgical treatment.
• These delays may lead to increased burn-related morbidity.
• Recommendations include improved resource allocation during peak seasons and enhanced burn prevention strategies.