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

The relationship between hospital volume and outcomes remains unclear in the delivery of burn care in resource-limited settings, where demand often exceeds capacity. We sought to characterize the association between burn patient volume and the use of operative intervention at a tertiary burn unit in Malawi.

This study examined patients admitted to Kamuzu Central Hospital located in Lilongwe, Malawi, over years 2011-2019. We described the association between the census at the time of admission and the use of operative intervention, as well as the time to operation. Patient census was defined as low (≤ 15 patients), medium (16-29 patients), and high (≥ 30 patients).

A total of 2484 patients were included. The mean daily burn unit census was 22.5 patients (SD 6.6) and varied significantly by season. For the medium and high census, the adjusted risk ratio of undergoing surgery was 0.79 (95% CI 0.64, 0.97) and 0.65 (95% CI 0.49, 0.85), respectively, adjusted for flame burn, age, %TBSA, and delayed presentation. At a low admission census, the adjusted mean time to operation was 17.2 days (95% CI 14.4, 20.1) compared to 28.3 days (95% CI 25.4, 31.2) at a high census.

In a resource-limited setting, an increasing mean daily census significantly reduced the use of operative intervention and increased time to operation, potentially increasing burn-associated morbidity. In order to improve the quality of burn care in similar environments, improved resource allocation during busier seasons and targeted burn prevention efforts are imperative.