51 Patient Reported Outcomes Following Rehabilitative Surgery in Burn Survivors

Abstract

Burn survivors have surgical needs after their incident hospitalization. Little is understood regarding what predicts these operations and their effect on patient reported outcomes (PROs). We aim to characterize the use of burn-related operations post-hospitalization and determine whether PROs change during this time. We hypothesized improvement in PROs following surgery adjusting for patient and burn factors. Adult burn survivors with complete data through 2 years post-hospitalization were extracted from the Burn Model Systems, a prospective observational database from 4 US burn centers. Surgical and non-surgical patients were compared. Predictor variables included patient and injury characteristics and inpatient procedures; these were modeled with logistic regression. Health states were measured with Veterans RAND 12 item health survey (VR-12). Burn-related operations were organized into 3 categories: wound, scar, and contracture. The average treatment effect of surgery was modeled with propensity score matching. 372 of 1,359 patients (27.4%) underwent ≥ 1 burn-related operation within 2 years of discharge. Factors that increased the likelihood of operations included number of operations at incident hospitalization (p<0.001), hand and perineal involvement (p=0.001 & 0.042), and range of motion limitation (p<0.001). VR-12 physical health scores rose for all cohorts except those needing wound operations. VR-12 mental health scores rose for those not receiving surgery, but stagnated or declined for surgical cohorts. After adjustment, scar related operations showed no significant changes in physical or mental component scores. Contracture operations were not significantly associated with changes to physical component scores, but showed a decline in mental component scores at 12-month visits (p<0.001). The number of operations at incident hospitalization was the strongest predictor of needing later surgery. Patients with ongoing surgical needs for wounds appear to have poorer quality of life than matched peers. Contracture and scar surgeries were not associated with gains in global well-being compared to matched non-surgical peers. Additional qualitative studies are needed to understand why these data suggest a discrepancy to what is observed in the clinical setting with regard to reconstructive surgery. Better informed shared decision making with patients when deciding on rehabilitative burn surgery.