Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay. Issue 1 (February 2020)

• Record Type: Journal Article
• Authors: Issler-Fisher, Andrea C.; Fisher, Oliver M.; Clayton, Nicola A.; Aggarwala, Shivani; Haertsch, Peter A.; Li, Zhe; Maitz, Peter K.M.
• Is Part Of: Burns. Volume 46:Issue 1(2020)
• Page Start: 65
• Page End: 74
• Publication Date: 2020-02
• Subjects: Severe burn scars -- Ablative fractional CO2 laser -- Ablative fractional resurfacing -- Reconstructive burn surgery -- Hospital length of stay -- Complex reconstructive procedures; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2019.01.004
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Burn reconstructive procedure types before and after ablative fractional CO2 laser introduction. Significant reduction in conventional and complex reconstructive operations. Significant reduction in anaesthetic times following ablative fractional CO2 laser implementation. Significant reduction in hospital admissions and hospital length of stay following ablative fractional laser introduction. Abstract: Background: Reconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported. Methods: Retrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO2 laser (CO2 -AFL). Results: The total number of acute burn patients treated at CRGH increased substantially over this timeframe, resulting in 412 elective procedures including 82 before and 330 after introducing CO2 -AFL. The proportion of traditional non-laser reconstructive procedures dropped considerably to 23.9% in about 2.5 years following CO2 -AFL introduction. This change in approach had a profound effect on LOS with average LOS being 1.96 days for non-laser and 0.36 days for CO2 -AFL-procedures (p < 0.001). Anaesthetic times also decreased significantly, with median durations at 90 min pre-laser and 64 min post-laser introduction (p < 0.001), and median anaesthetic times at 87 min (non-AFL) and 57 min (AFL procedures) (p < 0.001). Conclusion: AFL profoundly affects elective reconstructive burn case mix with a replacement of conventional reconstructive operations in favour of AFL-procedures. This results in reductions of average LOS and anaesthetic times. Consequently, increased use of AFL in burn scar management could potentially reduce overall costs associated with burn scar reconstruction.