Burns in the elderly: an early surgical approach

Forty-nine consecutive burned patients over the age of 50 years treated with an early surgical protocol of wound closure were studied prospectively to determine if early surgery had a beneficial effect on total hospitalization time or mortality. Surgery was performed within the first 72 to 96 hours postburn. Twenty-six patients (Group I) had burns less than 20% of the TBSA, range, 3 to 18%, with 0 to 10% full thickness. Seventeen (66%) of these patients had surgical closure of the wound. The mean hospitalization time was 16.3 days. Twenty-three patients (Group II) had burns greater than 20% TBSA, range, 20 to 81%, with 0 to 68% full thickness. Eight (35%) of these patients died and five of the deaths were due to cardiovascular collapse during the initial resuscitative phase. Fourteen patients had 37 operative procedures performed to close the burn wound. Twelve (86%) of these 14 patients survived and the mean hospitalization time of the surviving patients was 44 days. No anesthetic complications occurred in either group. Results of this study indicate that an early surgical approach to wound closure resulted in a greater than 25% reduction in total hospitalization time, and further, that this early surgical approach was not associated with any increase in mortality, but instead, appeared to be associated with a reduction in mortality (chi 2 = 8.10; p less than 0.01).