Abstract

Human cadaveric skin (allograft) is used in treating major burns both as temporizing wound coverage and a means of testing wound bed viability following burn excision. There is limited information on outcomes, and clinicians disagree on indications for application in intermediate-sized burns. This study aims to improve understanding of allograft use in 20–50% total body surface burns by assessing current utilization and evaluating inpatient outcomes. Discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality assessed 3,557 major burn patients (>20% total body surface area and ≥ second degree depth, 20–50% TBSA) undergoing operative treatment. Patient demographics and hospital characteristics were evaluated with multivariate logistic regression. Outcomes were evaluated with propensity score matching. The primary outcome was mortality with secondary outcomes including complications, length of stay, total burn operations, and charges. After matching, 771 allografted patients were paired with 2,786 controls. Covariate mean standard differences were all <10% after matching. The average treatment effect (ATE) of allograft on inpatient mortality was an increase of 3.2% (95% CI 0.9–5.5%, p=0.006). Allograft ATEs were all significantly higher for secondary outcomes: composite complication index increased 0.11 (95% CI 0.04–0.17, p<0.001), length of stay increased 9.5 days (95% CI 7.4–11.6 days, p<0.001), total burn operations increased by 1.6 (95% CI 1.4–1.8, p<0.001), and total charges increased $148,578 (95% CI $111,166–185,991, p<0.001). After adjusting for covariates, allograft use significantly increased inpatient mortality, and was associated with more complications, longer length of stay, more burn operations, and greater total charges. This analysis suggests that better studies are needed to justify the use of this costly and limited resource in intermediate-sized major burns. Inform providers on judicious use of allograft and negative repercussions in TBSA burns 20–50%.

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