839 Early Ambulation After a Lower Limb Burn Is Associated with Reduced Length of Stay: A Quantitative Longitudinal Study

Abstract

Abstract Introduction A lower limb burn arguably has a significantly greater effect than an upper limb burn due to the detrimental impact on ambulation and return to daily roles and function. The patterns of functional recovery following a lower limb burn are poorly understood and has only been studied in small cohorts. It was hypothesized that patients, following an early ambulation pathway will have a reduced length of stay (LOS), and improved functional outcomes compared to patients with delayed ambulation after burn or after surgery. Methods The study aimed to explore if the timing of ambulation after lower limb burn and after skin grafting influenced acute LOS and functional outcomes. The study examined patients between 2011–2019 who sustained a lower limb burn injury in two phases. In Phase I, a preliminary sample (2011–2016) of 1209 lower limb burn patients with 1215 burn events was extracted and their date of ambulation confirmed retrospectively from the digital medical record. Phase II, in progress since 2017, prospectively collected the dates of ambulation. The definition of ‘early ambulation’ varies significantly and is poorly described in the literature. This study defined early and late ambulation through the categorization of four ambulatory pathways in surgically managed patients. The outcomes measured were acute LOS, and the Lower Limb Functional Index (LLFI-10) at six weeks after the burn. Conservatively managed patients were described as a reference only and not further analysed. Results Ambulatory data was available for 95% of cases, and the cohort had a mean age of 37.3 years; 65.6 % were male; and, 57% required surgery. Late ambulation was associated with TBSA; presence of a foot burn; and, when patients burn occurred in a rural area. Phase I results confirmed early ambulation, particularly after surgery, was significantly associated with reduced LOS (p< 0.001). Excluding ICU cases (n=33), median LOS increase was 2 days where ambulation was delayed after surgery. Phase I results indicated a similar trend in LLFI-10 data. The pooling and analysis of Phase I and Phase II data underway now, will substantially increase the sample size and allow definitive understanding of the influence of sub-groups such as ICU patients on the outcomes of interest. Conclusions Ambulation by 48 hours after lower limb grafting surgery is associated with reduced acute burn unit length of stay. Applicability of Research to Practice Where appropriate, achieving early ambulation within two days after surgery will assist patients to progress more rapidly on their journey towards desired participation goals.