Early excision and grafting versus conservative management of burns in the elderly

David S. Kirn, Edward Luce

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Elderly burn patients have significantly higher mortality rates than younger patients with similar burns over the total body surface area. Two theories exist regarding treatment of burns in the elderly: a traditional approach to limit physiologic stress by avoidance of operative intervention in the early post-burn stage and eschar excision and wound closure within the first week of hospitalization. We examined retrospectively the outcome in patients 70 years or older, hospitalized in the University of Kentucky Burn Unit between 1975 and 1995. In the first decade (1975 to 1983), patients were managed conservatively, namely, with spontaneous eschar separation and late skin grafting. In the second half of the study period (1984 to 1994), elderly patients were managed by early operative excision (<7 days) and grafting. A total of 73 elderly patients were admitted to the unit, 6 of whom were not resuscitated and died shortly (<96 hours) after admission. Twenty-eight patients had early excision and grafting (average age 78.1 years, total body surface area 23.6 percent), and 39 were managed conservatively (average age 79.3 years, total body surface area 20.9 percent). The mortality rate was 57 percent in the first group and 41 percent in the second group (p = 0.22). In an effort to further define the two groups, the other patient variable that contributes to burn mortality besides age and total body surface area, inhalation injury, was subtracted and the mortality rates were recalculated. Excluding patients with inhalation injury, the mortality rate was 48 percent in the first group and 27 percent in the second group (p = 0.15). We conclude that, in our unit, the management of elderly patients by early excision and grafting was of no benefit and may have resulted in a higher mortality rate.

Original languageEnglish (US)
Pages (from-to)1013-1017
Number of pages5
JournalPlastic and Reconstructive Surgery
Volume102
Issue number4
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

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Burns
Body Surface Area
Mortality
Inhalation
Wounds and Injuries
Conservative Treatment
Burn Units
Skin Transplantation
Hospitalization

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Early excision and grafting versus conservative management of burns in the elderly. / Kirn, David S.; Luce, Edward.

In: Plastic and Reconstructive Surgery, Vol. 102, No. 4, 01.01.1998, p. 1013-1017.

Research output: Contribution to journalArticle

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