Impact of hospital procedure volume on inpatient outcomes of burns covering 20-50 % of the total body surface receiving skin allograft: An analysis of the US Nationwide Inpatient Sample 2005-2020.

Abstract

This study examined how hospital procedure volume influences outcomes of burn patients receiving skin allografts. Data of adults ≥ 18 years with burns of 20-50 % of the total body surface area who received skin allografts were extracted from the US Nationwide Inpatient Sample (NIS) database 2005-2020. Hospitals were categorized into low- and high-volume based on an annual number of skin allograft procedures, and patients were categorized by type of hospital at which they received treatment. Outcomes include mortality, complications, length of hospital stay, and safety indicators. Propensity score matching (PSM) ensured balanced comparisons. Following PSM, data from 1044 patients (representing 5118 persons in the US) were analyzed. Multivariable analysis revealed that high hospital volume was significantly associated with a lower risk of unfavorable discharge (adjusted odds ratio [aOR] = 0.74, 95 % confidence interval [CI]: 0.57, 0.97) and lower total hospital costs (adjusted beta = -129.44, 95 % CI: -142.93, -115.96 thousand USD). Stratified associations revealed that high hospital volume was associated with decreased risk of in-hospital mortality (aOR = 0.60, 95 % CI: 0.38, 0.95, p = 0.027) in patients ≥ 60 years old, and reduced risk of patient safety indicator (PSI) presence (aOR = 0.71, 95 % CI: 0.54, 0.92, p = 0.010) in the subgroup without comorbidities. Older patients with major burns treated with allografts at high-volume hospitals have lower costs, decreased risk of unfavorable discharge, lower in-hospital mortality rates, and reduced safety risks for those without comorbidities.