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Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa

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Abstract

Introduction

Early excision and grafting remains the standard of care after burn injury. However, in a resource-limited setting, operative capacity often limits patient access to surgical intervention. This study sought to describe access to excision and grafting for adult burn patients in a sub-Saharan African burn unit and its relationship with burn-associated mortality.

Methods

We analyzed patients recorded in the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi from 2011–2019. We examined patient characteristics, interventions, and outcomes for adults aged ≥16 years. Modified Poisson regression modeling was used to identify risk factors for mortality.

Results

Five hundred and seventy-three patients were included. Median age was 30 years (IQR 23–40) with a male preponderance (63%). Median percent total body surface area burned (%TBSA) was 15% (IQR 8–26) and 68% of burns were caused by flame. 27% (n = 154) had burn excision with skin grafting, with a median time to operation of 18 days (IQR 9–38). When adjusted for age, %TBSA, and time to presentation, operative intervention conferred a survival benefit for patients with flame burns with a RR 0.16 (95% CI 0.06, 0.42).

Conclusions

In a resource-limiting setting, access to the operating room is inadequate, and burn patients are not prioritized. While many scald burn patients may be managed with wound care alone, patients with flame burn require surgical intervention to improve clinical outcomes. Burn injury in this region continues to confer a high risk of mortality, and more investment in operative capacity is imperative.

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Acknowledgements

Study data were collected and managed using REDCap electronic data capture tools hosted at UNC. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.

Funding

Financial support was provided by the North Carolina Jaycee Burn Center in the Department of Surgery at the University of North Carolina for all aspects of the study including: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. School of Medicine, Department of Surgery, University of North Carolina, 4006 Burnett Womack Building CB 7228, Chapel Hill, USA

    Jared R. Gallaher, Laura N. Purcell & Anthony Charles

  2. Kamuzu Central Hospital, Lilongwe, Malawi

    Wone Banda & Anthony Charles

  3. College of Medicine, University of California, San Francisco, USA

    Brittany Robinson

Authors
  1. Jared R. Gallaher
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  2. Wone Banda
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  3. Brittany Robinson
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  4. Laura N. Purcell
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  5. Anthony Charles
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Correspondence to Jared R. Gallaher.

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Gallaher, J.R., Banda, W., Robinson, B. et al. Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa. World J Surg 44, 3629–3635 (2020). https://doi.org/10.1007/s00268-020-05684-y

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