The effect of early surgical intervention on mortality and cost-effectiveness in burn care, 1978-91

Abstract

A 14-year (1978-91) single centre analysis was performed involving 3561 patients. Several variables thought to influence burn outcome were included in the analysis, as was length of stay, interval between surgical interventions on each patient, and cost of care. Mortality rate declined by over 2 per cent (from 9.8 per cent during the first 7 years to 7.3 per cent in the second 7 years, P < 0.001). Multiple regression showed that percentage burn, presence of inhalation injury, and age had a significant effect on mortality. These variables, as well as the DRG distribution, were statistically evenly distributed over the 14-year study. There was a statistically significant decrease in length of stay (23 days in 1979 to 14.2 days in 1990), which significantly correlated with a decrease in interval between surgical interventions (14.76 days in 1979 to 6.12 days in 1990). The average annual increase of hospital charges for burn care grew at 9.6 per cent annually, higher than the consumer price index during the same time (5.8 per cent) but substantially lower than the hospital market as a whole (10.8 per cent). Mortality rate of major burns has decreased significantly in this study, while burn severity indices remained constant. Increase in cost of care was substantially lower than that of general hospital care. This apparent cost efficiency is driven by a decreased length of stay closely correlated with aggressive surgical intervention for closure of the burn wound.