Timing of surgical excision for burn wounds: A systematic evaluation and meta-analysis comparing early and delayed...

BackgroundThe optimal timing of burn wound excision remains controversial. We updated the evidence base by synthesizing data from comparative studies published from 1 January 2010 to 11 March 2024 that compared the outcomes of early and delayed excision in patients with thermal burns.MethodsThe PubMed, Embase, Cochrane Library, and Web of Science Core Collection databases were searched. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Random-effects meta-analysis was performed. Mortality was pooled as risk difference, and continuous outcomes were pooled as standardized mean differences with 95% confidence intervals. Prespecified subgroup analyses considered study design, country income group, and the operational definition of early excision. This systematic review and meta-analysis was formally registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 3 December 2024 (CRD42024621585).ResultsTen comparative studies (8 observational studies and two randomized controlled trials) involving 5070 patients fulfilled the eligibility criteria. Early excision was not associated with lower mortality than delayed excision (5 studies; risk difference: -0.01, 95% confidence interval: -0.06 to 0.03; p = 0.52; I² = 79%). Early excision was associated with a shorter duration of hospitalization (8 studies; standardized mean difference: -0.64, 95% confidence interval: -0.93 to -0.35; p < 0.001; I² = 94%). There were no statistically significant differences in the hospital cost (3 studies; standardized mean difference: -0.45, 95% confidence interval: -1.72 to 0.81; p = 0.48) or graft success rate (3 studies; standardized mean difference: 0.63, 95% confidence interval: -1.03 to 2.29; p = 0.46) between early and late excision. Sensitivity analyses did not materially change the direction of the main findings; however, there was substantial heterogeneity for several outcomes.ConclusionsEarly excision may shorten the duration of hospitalization for selected burn patients; however, no consistent mortality benefit was demonstrated. The available evidence for costs and graft success remains limited and highly heterogeneous; therefore, decisions pertaining to excision timing should be individualized within the broader perioperative burn-care pathway.