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The Association Between Burn Unit Census and Operative Intervention in a Resource-Limited Setting

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

The relationship between hospital volume and outcomes remains unclear in the delivery of burn care in resource-limited settings, where demand often exceeds capacity. We sought to characterize the association between burn patient volume and the use of operative intervention at a tertiary burn unit in Malawi.

Methods

This study examined patients admitted to Kamuzu Central Hospital located in Lilongwe, Malawi, over years 2011–2019. We described the association between the census at the time of admission and the use of operative intervention, as well as the time to operation. Patient census was defined as low (≤ 15 patients), medium (16–29 patients), and high (≥ 30 patients).

Results

A total of 2484 patients were included. The mean daily burn unit census was 22.5 patients (SD 6.6) and varied significantly by season. For the medium and high census, the adjusted risk ratio of undergoing surgery was 0.79 (95% CI 0.64, 0.97) and 0.65 (95% CI 0.49, 0.85), respectively, adjusted for flame burn, age, %TBSA, and delayed presentation. At a low admission census, the adjusted mean time to operation was 17.2 days (95% CI 14.4, 20.1) compared to 28.3 days (95% CI 25.4, 31.2) at a high census.

Conclusions

In a resource-limited setting, an increasing mean daily census significantly reduced the use of operative intervention and increased time to operation, potentially increasing burn-associated morbidity. In order to improve the quality of burn care in similar environments, improved resource allocation during busier seasons and targeted burn prevention efforts are 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

The Department of Surgery at the University of North Carolina provided funding for this study.

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Authors and Affiliations

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

    Jared Gallaher, Laura N. Purcell, Trista Reid & Anthony Charles

  2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi

    Wone Banda & Anthony Charles

Authors
  1. Jared Gallaher
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  2. Laura N. Purcell
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  3. Wone Banda
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  4. Trista Reid
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  5. Anthony Charles
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Contributions

JG contributed to study design, data acquisition, analysis, and drafting of manuscript. LP contributed to acquisition of data, analysis, and drafting of manuscript. WB contributed to study design, acquisition of data, and critical revisions of manuscript. TR contributed to study design, acquisition of data, analysis, and critical revision of manuscript. AC contributed to study design, analysis, drafting of manuscript, and project supervision.

Corresponding author

Correspondence to Jared Gallaher.

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Gallaher, J., Purcell, L.N., Banda, W. et al. The Association Between Burn Unit Census and Operative Intervention in a Resource-Limited Setting. World J Surg 45, 1686–1691 (2021). https://doi.org/10.1007/s00268-021-06037-z

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  • DOI: https://doi.org/10.1007/s00268-021-06037-z

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