Preliminary Analysis of American Burn Association National Burn Repository to Investigate Impact of Cellular,...

Cellular, acellular, and matrix-like products (CAMPs), also known as skin, dermal, or tissue substitutes, have been used to manage thermal injuries for over 20 years with over 75 commercially available products today. Despite demonstrating long-term safety and efficacy, the use of CAMPs remains controversial in the burn community in terms of clinical benefit, economics, clinical algorithm, and lack of standardization in coding or categorization of specific products. Most clinical studies regarding CAMP use are product-specific prospective or retrospective studies comparing against split-thickness skin grafts alone, but very few have investigated the impact of product-agnostic CAMP use in burn care using the National Burn Repository (NBR). The goal of this study was to document CAMP use in burn management from 2016 to 2021 and provide a preliminary analysis of how CAMP use, including non-autologous and synthetic "tissue substitutes" categorization, may impact patient care compared to not using a CAMP at all. National Burn Repository data from 2008 to 2021 were analyzed (n = 388 775 patients). Surviving patients treated with complete procedure code data treated "tissue substitute" (synthetic or non-autologous) during their care were identified via ICD-10 procedure codes (n = 29 919 patients, 2016-2021 data). Aggregated metrics included patient demographic information (age, sex, race, and burn degree) and case measurements (length of stay [LOS], total body surface area [TBSA: second, third, and combined], complications, resource utilization, number of procedures, and number of excisional debridements). Additional analyses included determining the percentage of second- and third-degree burns (normalizing against total TBSA to obtain patient cohorts that are defined as "Predominantly second" and "Predominantly third") and normalizing patients' LOS per TBSA. An additional surviving patient cohort that was not treated with a CAMP (n = 46 589 patients) was identified to directly compare the case measurements listed above. The general frequency of patients treated with CAMPs has increased from 2016 to 2020. However, the number of patients treated with a CAMP, except patients aged 70 years or older, decreased from 2020 to 2021. Patients with predominantly second-degree burns were treated with CAMPs more often than those with predominantly third-degree burns. CAMP use, regardless of burn depth or normalization against TBSA, was associated with higher LOS/TBSA and more procedures overall, but also associated with a significantly lower rate of skin, wound, or graft-loss-related complications and fewer resources utilized overall compared to patients not treated with a CAMP. Cellular, acellular, and matrix-like product/Skin substitutes separated into non-autologous and synthetic tissue substitutes categories demonstrated significant differences, but should be considered preliminary due to limitations in data collection. This study illustrates the first analysis of the ABA NBR to investigate specific care algorithms (CAMP use) in burns, including high TBSA burns. This begins to retrospectively elucidate outcomes associated with one care pathway or another, and ultimately highlights the general lack of standardization in burn care approach, documentation in the NBR, and coding. Future analysis will be required to add further specificity and validation of these results, and to understand the health economic implications of CAMP use for burns.