83 Outcomes Using Autologous Epidermal Autograft for Wound Closure of Majority Deep Partial Thickness Burns

TL;DR

This study compares autologous epidermal autograft and traditional grafting for deep partial thickness burns, finding mixed effects on hospital costs and length of stay.

Contribution

The study provides new empirical evidence on the clinical and economic outcomes of using AEAG for deep partial thickness burns.

Findings

AEAG reduced the need for STAG in all patients.

For burns ≥20% TBSA, AEAG was linked to shorter hospital stays without increased costs.

In smaller burns (10-19% TBSA), AEAG was associated with higher costs and longer stays.

Abstract

Autologous epidermal autografting (AEAG) closes wounds with a significantly smaller donor site compared with traditional split thickness autograft (STAG). Theoretically, treatment of large burns with a smaller required donor site may reduce length of stay (LOS) and overall costs. We hypothesized that AEAG would be associated with reduced overall hospital costs in patients with ≥10% total body surface area (TBSA), majority deep partial thickness burns compared to STAG alone.

Burn center patients from 2018-2023 with ≥10% TBSA, operative, majority deep partial thickness burns were split into two groups based on treatment strategy: Group 1 – patients who underwent STAG only versus Group 2 - patients who underwent AEAG with STAG reserved only for full thickness areas. Primary outcomes included length of stay and overall costs. Groups were stratified by percent TBSA (10-19% and ≥20%). Univariate and multivariate analyses were performed.

The entire cohort included 97 patients, 50 (52%) in Group 1 and 47 (48%) in Group 2. The majority of the cohort (n=63, 65%) had 10-19% TBSA burns and 34 (35%) had ≥20% TBSA burns. In the 10-19% stratum, there were no differences in demographics or injury characteristics. Groups 1 and 2 had similar lengths of stay but Group 2 had higher overall costs. In the ≥20% TBSA stratum, there were no differences in demographics or injury characteristics except that Group 2 had a higher proportion of male patients. In the 10-19% TBSA stratum, after adjusting for age and TBSA, Group 2 was associated with increased costs (RR 1.46, 95% CI 1.18–1.80, p=0.001) and LOS (RR 1.16, 95% CI 1.00–1.34, p=0.045). In the ≥20% TBSA stratum and after adjusting for age and TBSA, Group 2 was associated with no difference in cost (RR 0.89, 95% CI 0.45 – 1.69, p=0.717) and a reduction in LOS (RR 0.78, 95% CI 0.68–0.88, p< 0.001).

For ≥10% TBSA, majority deep partial thickness burns, the use of AEAG with STAG reserved only for full thickness areas was associated with a reduction in the need for STAG. There is a potential for reduced length of stay without increased costs in burns ≥20% TBSA with AEAG use. However, a larger, adequately powered trial is necessary to validate this finding.

AEAG was associated with a reduction in overall STAG requirement in all patients and was not associated with an increased cost for large % TBSA majority deep partial thickness burns.

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