17 The Impact of Modifiable Comorbid Conditions on Long-term Patient Reported Outcomes in Burn Survivors

Abstract

Abstract Introduction Pre-existing comorbidities in burn survivors increase the risk of death and negatively impact quality of life. Investigations to date have only evaluated comorbidities as cumulative indices, which prevents identification of specific conditions for risk reduction after injury. Therefore, we aimed to evaluate the differential effects of specific conditions on patient reported outcomes. Methods A prospectively maintained trauma registry was merged with a longitudinal burn database using unique patient identifiers for burn survivors from 2007–2018. Admission comorbidities included: chronic liver disease, diabetes, hypertension, chronic pulmonary disease, chronic gastrointestinal disease, malignancy, cerebrovascular accident, congestive heart failure, bleeding disorder, coagulopathy, congenital condition, psychiatric illness, major depressive disorder, smoking status, alcohol use disorder, substance use disorder, trauma history, and steroid use. Demographic and burn related variables included age, gender, race, surface area burned, and number of operations during admission. Health related quality of life was assessed using the Short Form-12/Veterans RAND 12(SF/VR-12©) health survey component scores at 6, 12, & 24 months post injury. SF/VR-12 outcomes were evaluated with generalized linear models. Results The dataset included 493 adult participants of which 354 were male (71.8%). Median burn size was 14% TBSA (IQR 5%, 28%), and mean age was 45.0±16.3 years. 343 participants (69.6%) had ≥1 comorbidity, with a mean of 1.32±1.30 comorbidities/participant. SF/VR-12 mental component scores at 6 and 12 months post injury were negatively associated with history of psychiatric illness (p< 0.001, p=0.013); there were no significant predictors at 24 month follow up. SF/VR-12 physical component scores were negatively associated with smoking (p=0.019), diabetes (p=0.001), alcohol use disorder (p=0.001), and history of CVA (p=0.005) at 6 month follow up. 12 month SF/VR-12 physical component scores were negatively associated with trauma history (p=0.001), diabetes (p=0.042), and CHF (p=0.016). 24-month SF/VR-12 physical component scores were negatively associated with psychiatric illness (p=0.003). Conclusions Smoking, alcohol use disorder, and diabetes were associated with lower physical component scores 6-months after injury; diabetes persisted a negative covariate at 12 months. Psychiatric illness was negatively associated with mental component scores at 6 and 12 months after injury. Burn survivors may benefit from integrated diabetes management and mental health treatment during their rehabilitation. Applicability of Research to Practice Specific comorbid conditions differentially affect quality of life in burn survivors. Targeting management of specific conditions during recovery may improve quality of life.