Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay

Abstract

Background: Reconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported.

Methods: Retrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO₂ laser (CO₂-AFL).

Results: The total number of acute burn patients treated at CRGH increased substantially over this timeframe, resulting in 412 elective procedures including 82 before and 330 after introducing CO₂-AFL. The proportion of traditional non-laser reconstructive procedures dropped considerably to 23.9% in about 2.5 years following CO₂-AFL introduction. This change in approach had a profound effect on LOS with average LOS being 1.96days for non-laser and 0.36days for CO₂-AFL-procedures (p<0.001). Anaesthetic times also decreased significantly, with median durations at 90min pre-laser and 64min post-laser introduction (p<0.001), and median anaesthetic times at 87min (non-AFL) and 57min (AFL procedures) (p<0.001).

Conclusion: AFL profoundly affects elective reconstructive burn case mix with a replacement of conventional reconstructive operations in favour of AFL-procedures. This results in reductions of average LOS and anaesthetic times. Consequently, increased use of AFL in burn scar management could potentially reduce overall costs associated with burn scar reconstruction.

Keywords: Ablative fractional CO(2) laser; Ablative fractional resurfacing; Complex reconstructive procedures; Hospital length of stay; Reconstructive burn surgery; Severe burn scars.