99 Hand Burns: An Independent Risk Factor for Worse Hospital Outcomes

Abstract

Abstract Introduction Hand burns cause disability, loss of productivity, and psychological distress. While rarely life-threatening, hand burns are life-altering. There are limited large-scale investigations on the prevalence of hand burns and the impact on hospital outcomes. We present the first National Burn Repository (NBR) study on the prevalence of hand burns and associated outcomes. Methods We used NBR Version 8.0 to identify patients who sustained isolated and non-isolated hand burns. These patients were then sub-stratified into operative vs. non-operative hand burns and compared with non-hand burns as controls. Patient demographics and hospital outcomes (mortality, length of stay [LOS], intensive care unit LOS [ICU LOS], hospital charges) were collected. Multivariable logistic and multiple linear regressions determined the effect of hand burns on outcomes adjusting for age, %TBSA, full-thickness involvement, and inhalation injury. Results Of 172,640 NBR patients, 47,424 patients had hand burns and 5,870 (12%) were operative. Patients with hand burns had significantly larger %TBSA burns (12±18% vs. 7±8%, P< 10–4), more full-thickness involvement (6±16% vs. 2±6%, p< 10–4), a higher prevalence of inhalation injury (7% vs. 5%, p< 10–4), were more often male (73% vs. 66%, p< 10–4), higher mortality (5% vs. 2%, p< 10–4), longer LOS (12±22 vs. 8±21 days, p< 10–4) and ICU LOS (7±18 vs. 3±10 days, p< 10–4). Similarly, operative hand burns had longer LOS (25±30 vs. 10±20, p< 10–4) and ICU LOS (25±29 vs. 12±22, p< 10–4) but lower mortality (3% vs. 6%, p< 10–4) than non-operative hands. When controlling for age, sex, TBSA, full-thickness involvement, and inhalation injury, the presence of hand burns significantly predicted higher mortality (OR=1.6, 95% CI 1.5–1.8, p< 10–4) and prolonged ICU stays by 0.79 days (p=0.003), but was not associated with prolonged LOS (p >0.05). Billing data revealed significantly higher hospital charges ($114,608±294,289 vs. $58,314±158,758, p< 10–4) in patients with hand burns (N=17,140) compared to those without (N=12,530). Conclusions Patients with hand burns had worse inpatient outcomes and were also more costly to the healthcare system. Practitioners must pay close attention to hand burns as the cost to the system and society warrants improved management. In a society increasingly focused on value and quality, additional investigations are needed to understand how we can better treat hand burns to decrease inpatient morbidity. Applicability of Research to Practice Granular data for the hospital course of patients with hand burns may better elucidate why they require more healthcare resources than others.