Does patient load affect clinical outcome of burn patients in specialized centers? An analysis of the German Burn Registry

J L Schiefer; M Bagheri; P C Fuchs; R Lefering; H O Rennekampff; P M Vogt; The German Burn Registry; M N Busche

doi:10.1016/j.burns.2022.02.005

Does patient load affect clinical outcome of burn patients in specialized centers? An analysis of the German Burn Registry

Burns. 2022 May;48(3):539-546. doi: 10.1016/j.burns.2022.02.005. Epub 2022 Feb 8.

Authors

J L Schiefer¹, M Bagheri², P C Fuchs², R Lefering³, H O Rennekampff⁴, P M Vogt⁵, The German Burn Registry⁵, M N Busche⁶

Affiliations

¹ Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany. Electronic address: schiefer.jennifer@gmail.com.
² Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
³ Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany.
⁴ Department of Plastic, Aesthetic and Burn Surgery, Rhein-Maas Klinikum, Würselen, Germany.
⁵ Hannover Medical School, Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery, Hannover, Germany.
⁶ Hannover Medical School, Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery, Hannover, Germany; Leverkusen Hospital, Department of Plastic and Aesthetic Surgery, Burn Surgery, Leverkusen, Germany.

PMID: 35210141
DOI: 10.1016/j.burns.2022.02.005

Abstract

Hospital volume has been identified as an independent outcome parameter for a number of medical fields and surgical procedures, and there is a tendency to increase required patient numbers for center verification. However, the existing literature does not support a clear correlation between patient load and clinical outcome in adult burn care and recent data from Germany does not exist. We therefore evaluated the effect of patient volume in German burn centers on clinical outcome. Patient data was extracted from the German Burn Registry from 2015 to 2018. For better inter-center comparability, solely burn patients with a TBSA ≥ 10% were included. Mortality, number of surgeries and length of stay (LOS) were evaluated with respect to burn center patient volume. Burn center volume was divided into two and three groups. A total of 2718 patients with a TBSA ≥ 10% were admitted to the participating 17 burn centers. Independent from the division of patient data into either 2 or 3 groups, the TBSA and ABSI score-related severity of burn injuries were comparable between groups. There was no significant difference in mortality due to center size. Nevertheless, patients treated in large volume burn centers showed a significantly increased LOS (+4.5 days, [1.9-7.2] CI, p = 0.001) and required significantly more surgeries (+0.5 surgeries [0.2-0.8] CI, p = 0.002) when compared to the small volume centers. A similar phenomenon regarding mortality and LOS (p 0.001) was observed after dividing the centers into two groups. Interestingly a division into three groups showed significant differences with the best outcome for patients in medium-volume centers. Nevertheless, mortality did not differ significantly. Therefore, our data demonstrates that in contrast to many other medical fields, outcome and mortality are not automatically improved in burn care by simply increasing the patient load, at least in centers treating 20-100 BICU patients/year.

Keywords: Burn center size; Burn centers; Burn patient load; Mortality.

MeSH terms

Adult
Burn Units
Burns* / therapy
Germany / epidemiology
Humans
Length of Stay
Registries
Retrospective Studies