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When To Cut? Differences In Outcomes Between Early And Ultra-early Excision Of Burn Injuries With >=20%TBSA.
Tomer Lagziel, BS, Joshua Yoon, MD, Sophie Cemaj, BS, Julie Caffrey, DO, MS, Eliana FR Duraes, MD, PhD, Charles S. Hultman, MD, MBA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE: Delaying excision 24-48 hours post-injury has been thought to allow resuscitation and correction of physiologic derangements to optimize surgical outcomes. However, the precise optimal time-to-excision remains unknown. We aim to assess whether ultra-early-excision and grafting (24-72 hours) is better-than or equivalent-to early-excision and grafting (72 hours-6 days) in adults with burns >20%TBSA.
METHODS: We performed a retrospective analysis of adults admitted to our institution with burns of >20%TBSA, requiring resuscitation. Two study groups were established based on median time-to-excision and their outcomes were compared. We assessed blood-loss during initial surgery, transfusion requirements, pain-levels, daily analgesic requirements, hospital-acquired complications, readmission rates, hospital length-of-stay (LOS), and mortality.
RESULTS: Preliminary data of 40 patients with >20%TBSA showed a median time-to-excision of 72 hours. Mean time-to-excision was 2.17 days for the ultra-early group and 4.38 days for the early group. Near-equivalent outcomes were observed for transfusion requirements, estimated blood-loss, pain-levels, analgesic requirements, mortality, readmission, and LOS. However, ultra-early showed fewer hospital-acquired complications.
CONCLUSION: Ultra-early-excision (<72 hours) versus early-excision (72 hours-6 days) of burn wounds showed similar clinical outcomes for blood-loss, transfusion needs, daily analgesic requirements, LOS, readmission, and mortality. However, ultra-early-excision was associated with less hospital-acquired complications, compared to early-excision. This data supports the concept of ultra-early excision and strongly argues in favor of a randomized, controlled trial to help define the optimal timing of burn wound excision.

Patient Demographics and Outcomes
Ultra-Early Excision (n = 22)Early Excision (n = 18)P-Value
Age (y)49.651.5NS
SexMale (77%), Female (23%)Male (78%), Female (22%)NS
%TBSA41.437.5NS
Time-to-Excision(hours)52 (2.17 days)105 (4.38 days)<0.01*
Blood-Loss (mL)626621NS
pRBC transfused (mL)596666NS
Pain Score5.35.85NS
Analgesic Requirements (MME)6378NS
Hospital-Acquired Complications (%)3664<0.05*
30-Day Readmission (%)87NS
Hospital LOS (days)4140NS
Mortality (%)1614NS


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