548 Outcomes of Minimally Invasive Excision, Epidermal Autografting, and Skin Substitute in Adult Mid-deep Dermal Burns

TL;DR

A new burn treatment method called MEP improves healing rates and reduces infections in adult patients with mid-deep dermal burns, despite higher costs.

Contribution

This study introduces MEP as a viable alternative to traditional burn care with better healing outcomes and infection reduction.

Findings

MEP patients had 82.1% healing by day 10 compared to 38.5% in the standard care group.

MEP patients had no infections, while 23.1% of standard care patients had infections.

MEP had higher total charges but a higher percentage of charges were paid compared to standard care.

Abstract

The standard of care (SOC) for adult mid-deep dermal burns typically involves conservative management with delayed surgery if indicated. This study evaluates the outcomes of Minimally invasive excision with Epidermal autografting and Poly-lactic acid skin substitute (MEP) compared to SOC.

A retrospective review of adult burn patients from 2021 to 2024 undergoing MEP for mid-deep dermal burns compared to a propensity-matched SOC group (matched by age, TBSA, and injury mechanism) from 2017-2020. Outcomes included length of stay (LOS), 90%+ healed burns by post-operative or post-burn day ten, number of sedations required and infections. Financial outcomes utilized actual patient charges, cost:charge ratio and payments received. Descriptive statistics were used for demographics and univariate regression analyses were used to assess MEP’s impact on LOS, sedations, infections and time to healing.

There were 44 patients that met inclusion criteria, of which 39 were propensity matched to a SOC group. No differences in age, sex, %TBSA and etiology. MEP patients had a longer median length of stay (4.0 vs. 2.0 days, p=0.008) and required more sedations (median of 1vs 0, p = < 0.001). There was a significant difference in the number of infections that occurred as no infections occurred in the MEP group compared to 23.1% in SOC (p=0.002). By day 10, 82.1% of MEP patients achieved ≥90% healing compared to 38.5% of SOC (p=0.001). Lastly, the total charges, as anticipated, were higher in the MEP group (median $84,982.51 vs. $15,524.34, p< 0.001). In the SOC group, 42% of charges were paid and 46% in the MEP group.

Univariate regression analysis was then utilized to better assess the relationship between MEP as a single predictor variable and each outcome measure, which demonstrated that MEP was not significantly associated with LOS (p = 0.26) or number of sedations required (p=0.37). However, the analysis demonstrated MEP patients were five times more likely to achieve ≥90% healing (p=0.002) by post-operative/burn day ten.

MEP patients were five times more likely to achieve ≥90% healing by day ten and had no infections while not significantly affecting LOS or sedations required. As expected, charges were higher in the MEP group, however, with a higher percentage of charges paid, MEP is financially sustainable. MEP represents a viable alternative to traditional, conservative methods of burn care for mid-deep dermal burns in adult patients.

Integration of MEP into clinical practice could lead to a shift in burn management that prioritizes quality and service, while being financially sound.

N/A