545 The Association of Plastic Surgery Facility Volume with Inpatient Burn Outcomes

Abstract

Abstract Introduction Acute burn care involves a spectrum of physicians, nurses, and allied health professionals. Similarly, burn surgeons have variable training backgrounds that originate from different specialties. Plastic surgery was founded on the core principles of reconstruction and offers the full spectrum of acute burn care and reconstructive surgery. Previous work has shown that variations in practice within burn surgery are partially driven by training background. We hypothesize that plastic surgery involvement and access to the full reconstructive paradigm will improve inpatient outcomes in the treatment of burn injuries. Methods Acute burn patients with known percent total body surface area (%TBSA) were extracted from the National Inpatient Sample (NIS) from 2012–2014 based on International Classification of Disease 9th Edition codes. Plastic surgery volume per facility for the entire NIS was determined based on ICD-9 codes for flap procedures, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators (venous thromboembolic event, sepsis, surgical bleeding, pneumonia, wound complications) and mortality. Regression models included the following variables: age, %TBSA, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status. Results The weighted sample included 99,510 burn admissions with a mean age of 37.2 years (standard deviation [SD] 24.3) and mean %TBSA of 12.4% (SD 12.4%). The weighted median plastic surgery volume by facility was 245 cases per year (Interquartile range 115, 495). Compared to the lowest quartile, the upper three quartiles of plastic surgery volume were associated with an increased likelihood of undergoing a flap procedure during admission (p< 0.05). Plastic surgery volume was also associated with decreased likelihood of patient safety indicator events, whereby the highest quartile showed an OR of 0.71 (95% confidence interval 0.59–0.85, p< 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death. Conclusions Burn patients treated at high volume plastic surgery facilities were more likely to undergo flap procedures during their admission compared to low volume centers. High volume plastic surgery facilities were associated with lower likelihood of inpatient complications, although there were no differences in mortality. Applicability of Research to Practice Inform health systems design in the delivery of burn care to provide the best outcomes for burn survivors.