Burns, Aging, and Appalachia: The Untold Story of Hospital Stays

Background Burn injuries are among the top 10 causes of trauma and premature death globally. While burns are more prevalent in low-income countries, geriatric burns are disproportionately observed in developed nations, where longer life expectancies result in a larger elderly population. Geriatric burn patients face unique challenges, including slower healing, higher risk of complications, and increased hospital length of stay (LOS), which may be further exacerbated in resource-limited regions such as Appalachia. This study investigates factors influencing hospital LOS in geriatric burn patients aged 65 and older in a resource-constrained region of Appalachia. Variables analyzed include patient demographics, comorbidities, burn-specific characteristics, and the regional healthcare context. Methodology This retrospective cohort study analyzed 209 patients admitted to Cabell Huntington Hospital's Burn Intensive Care Unit between 2017 and 2023. Variables included age, gender, burn severity, total burn surface area (TBSA), inhalation injuries, burn source, comorbidities (chronic obstructive pulmonary disease (COPD), diabetes), smoking history, body mass index, home oxygen use, and discharge status. Statistical analyses included t-tests, analysis of variance, and multivariate regression to identify predictors of LOS. Results The mean LOS was 11.7 ± 10.3 days. Factors significantly associated with longer LOS included inhalation injuries (+8.3 days, p = 0.001) and full-thickness burns (+7.9 days, p < 0.001). Patients who died had significantly longer hospital stays (+5.6 days, p = 0.021). Surprisingly, home oxygen use was associated with shorter LOS (-5.1 days, p = 0.011). Furthermore, discharge status was significant. Patients who expired in the hospital had a longer LOS (+5.6 days, p = 0.021). Age, gender, and comorbidities (COPD, diabetes, smoking) did not significantly impact LOS in this cohort. Higher TBSA was associated with longer LOS (p < 0.001). For every 1% increase in TBSA, LOS increased by an average of 0.445 days. Conclusions Inhalation injuries, burn severity, and burn source are significant predictors of LOS in geriatric burn patients in Appalachia, while regional resource limitations may uniquely influence care outcomes. Identifying factors affecting LOS can guide tailored interventions to improve recovery and reduce hospital stays in resource-constrained settings. Further research is warranted to explore regional disparities in burn care.