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Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study
Bastian Bonaventura1, Adriana C Panayi1, Kamal Hummedah1
1Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
Insights
Burns affecting the perineum, buttocks, and genitals (PBG) are linked to increased mortality. Even after accounting for other factors, PBG burns independently predict a higher risk of death in burn patients.
Area of Science:
- Burn injury research
- Trauma surgery
- Clinical outcomes analysis
Background:
- Perineum, buttocks, and genitals (PBG) burns present unique therapeutic challenges and poorer outcomes.
- Previous studies suggest PBG burns are associated with increased morbidity and mortality.
Purpose of the Study:
- To determine if PBG burns are an independent predictor of mortality, morbidity, and complications.
- To compare outcomes in patients with and without PBG burns in a large, diverse patient cohort.
Main Methods:
- Retrospective analysis of 1024 patients admitted to a level one burn center (August 2014 - July 2022).
- Stratification into PBG burns and control (CTR) groups.
- Multivariate regression and propensity score matching to analyze outcomes including mortality, length of ICU stay (LOS-ICU), and length of in-hospital stay (LOHS).
Main Results:
- PBG burn patients were older, more frequently female, and had larger total body surface area (TBSA) burns with higher rates of full-thickness (FT) burns.
- Scald burns were a more common etiology for PBG burns, and these patients required more surgical procedures.
- PBG burns were independently correlated with increased LOS-ICU and, after matching, were a significant predictor of mortality (p=0.0003).
Conclusions:
- PBG burns necessitate prolonged intensive care and hospitalization, with increased risk of complications.
- The presence of PBG burns is an independent risk factor for mortality, regardless of patient age, TBSA, or other covariates.
Background:
Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns.
Patients And Methods:
Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes.
Results:
A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003).
Conclusion:
PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.
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