C. N. Bartley1, K. Atwell1, B. Cairns1, A. Charles1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA
Introduction: Amputation following burn injury is a rare occurrence. Nevertheless, the physical, psychological, and socioeconomic consequences are substantial. Previous studies describe the risk of amputation after electrical burn injuries and/or only involve a small number of patients. Therefore, we will describe the distribution of amputations and evaluate for predictors of amputation after burn injury for all burns admitted to a large regional burn center.
Methods: We conducted a retrospective analysis of patients ? 17 years admitted from January 2002 to December 2015. Baseline patient and injury characteristics included sex, age, %TBSA, race, burn etiology, and the presence of a concomitant inhalation injury. Patients who underwent an amputation procedure were compared to those who did not. A multivariate logistic regression model was used to determine the risk factors for amputation. Amputations were further categorized by location (upper vs lower extremity) and type (major vs minor) for comparison. Additionally, patient characteristics of those who underwent an amputation procedure were compared by etiology (electrical vs thermal) to assess for potential differences.
Results: Of the 8,313 patients included for analysis, 1.4% underwent an amputations(s) (n = 119). Amputees were older (46.7 ± 17.4 years) than patients with no amputations (42.6 ± 16.8 years) (p = 0.009). Black (39.5%) and Hispanic (8.4%) patients were more likely to have an amputation procedure. The most common burn etiology for amputees was flame (41.2%) followed by electrical (23.5%) and other (21.9%). Median CCI was 0 for both the amputation and no amputation patients (p = 0.030). Patients in the amputation group had a higher median TBSA compared to those in the no amputation group (6% vs 3%, p <0.001). Black race (OR 2.29; 95% CI 1.22 – 4.30), CCI (OR 1.29; 95% CI 1.05 – 1.59), electric (OR 13.54; 95% CI 6.23 – 29.45) and other (OR 4.24; 95% CI 1.84 – 9.81) burn etiology, and %TBSA (OR 1.03; 95% CI 1.02 – 1.05) were found to be associated with an increased odds of amputation.
Conclusion: Our study confirms previous findings that electrical burns are associated with an increased risk of amputation. We also found that other burn types, the presence of pre-existing comorbidities, black race, and increased %TBSA are predictors of amputation in a population of burn patients admitted to a regional burn center. The role of comorbidities and race on the risk of amputation requires further investigation.