Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study

Bastian Bonaventura; Adriana C Panayi; Kamal Hummedah; Alen Palackic; Christian Tapking; Valentin Haug; Katja Kilian; Alexander Runkel; Bjoern Bliesener; Ulrich Kneser; Gabriel Hundeshagen

doi:10.1016/j.burns.2023.10.003

Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study

Burns. 2024 Apr;50(3):767-773. doi: 10.1016/j.burns.2023.10.003. Epub 2023 Nov 7.

Affiliations

¹ Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
² Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
³ Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany. Electronic address: gabrielhundeshagen@gmail.com.

PMID: 38036375
DOI: 10.1016/j.burns.2023.10.003

Abstract

Background: Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns.

Patients and methods: Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes.

Results: A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003).

Conclusion: PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.

Keywords: Bacteremia; Burns; Buttocks; Genital; Perineal; Propensity Score Matching.

MeSH terms

Bacteremia*
Burns* / epidemiology
Burns* / therapy
Buttocks
Female
Genitalia / injuries
Humans
Length of Stay
Lung Injury*
Perineum / injuries
Retrospective Studies