# Burn patients’ perceptions of skin grafting in China: a single-center retrospective cohort study with paired pre-post assessment

## TL;DR

This study found that skin grafting reduces anxiety and fear in Chinese burn patients, with factors like facial burns and multiple surgeries increasing postoperative anxiety.

## Contribution

The study identifies modifiable factors influencing psychological outcomes after skin grafting in Chinese burn patients.

## Key findings

- Preoperative anxiety and fear significantly decreased after skin grafting.
- Facial/hand burns and multiple surgeries were independent predictors of postoperative anxiety.
- Dual support (family plus clinician education) significantly reduced anxiety levels.

## Abstract

This study aimed to quantify changes in psychological perceptions before and after skin grafting and to identify key modifiable factors influencing these perceptions in Chinese burn patients.

A single-center retrospective cohort study analyzed paired pre- and post-operative survey data from adult inpatients who underwent skin grafting between January 2018 and December 2021. Preoperative (1–3 days before surgery) and postoperative (at discharge) data were extracted from the medical records of 475 patients. Surveys assessed anxiety (Numerical Rating Scale, NRS; Hospital Anxiety and Depression Scale, HADS), fear (NRS), depression (HADS), and perceptions of grafting. Multivariate linear regression controlled for confounders including age, sex, burn site, number of surgeries, burn area, and donor site area.

Preoperative anxiety (NRS 4.86 ± 2.76) and fear (2.90 ± 2.50) decreased significantly after grafting (anxiety: 3.03 ± 2.48, p < 0.0001; fear: 2.21 ± 2.07, p < 0.0001). Multivariate analysis identified facial/hand burns (β = 0.18, p = 0.003) and multiple surgeries (β = 0.12, p = 0.028) as independent predictors of postoperative anxiety. Postoperative pain was common (56.6%) and correlated with residual anxiety (r = 0.42, p < 0.01). Patients receiving dual support (family plus clinician education) had significantly lower anxiety levels than those with non-dual support (3.92 ± 2.11 vs. 5.74 ± 2.83, p < 0.001). Prominent preoperative knowledge gaps (e.g., regarding graft failure risk) showed substantial postoperative improvement (p < 0.001).

Preoperative anxiety and fear are prevalent but modifiable. The identification of independent predictors enables risk stratification for psychological support. The correlation between pain and anxiety and the benefit of dual support highlight the need for integrated, multidisciplinary care. These findings support embedding structured education and support systems into burn care pathways. Future prospective trials are warranted.