Early Surgery and Outcomes in Severe Burns: A Prospective Multicenter Observational Study.

Abstract

To examine the association between the timing of surgical excision and survival in severely ill burn patients. The optimal timing of surgical excision in severe burns remains uncertain. Early excision may limit systemic inflammation but may also increase hemodynamic instability. This prospective, multicenter, observational cohort study (December 2016-December 2022) included adults (18 y of age or older) admitted within 72 hours of injury with burns involving >20% TBSA across 6 French centers. Early surgery was defined as the first excision within 48 hours. The primary outcome was 90-day all-cause mortality. Secondary outcomes included ICU and 28-day mortality, organ failure, acute kidney injury, ARDS, secondary infections, sepsis, and ICU length of stay. Associations were estimated using AIPTW and targeted maximum likelihood estimation. Among 448 patients (median age 47 y; 65% male; median TBSA 33%), 90 (20%) underwent early and 358 (80%) delayed excision. Early-excision patients had more extensive burns and higher severity scores. After adjustment, delayed excision was associated with higher 90-day mortality (aOR: 2.3, 95% CI: 1.2-4.1; P=0.007), higher ICU mortality (aOR: 3.1, 95% CI: 1.5-6.3; P=0.001), and higher 28-day mortality (aOR: 2.9, 95% CI: 1.3-6.7; P=0.007). Sepsis or septic shock occurred more often in the early group (53% vs. 32%; aOR: 0.56, 95% CI: 0.38-0.83; P=0.004). No significant differences were found for other secondary outcomes. Early surgical excision within 48 hours was associated with lower adjusted 90-day mortality in adults with severe burns, supporting early excision as part of modern burn management strategies.