BURN CARE: DOES HOSPITAL TYPE MAKE A DIFFERENCE?
Shevonne S. Satahoo MD1, Katherina Julien BS1, Louis R. Pizano MD MBA1, Carl I. Schulman MD PhD MSPH1,
Nicholas Namias MD MBA1
1
DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
Background: Approximately 450,000 burn injuries receive medical treatment across the United States per year.
These patients are then treated in a variety of hospital settings; and not all are at a burn center. Despite this variation,
we hypothesized that burn care and outcomes would be similar across all groups.
Methods: The Nationwide Inpatient Sample (NIS was queried for all patients ≥ 18 years with ICD-9 codes for burn
injuries, excluding isolated eye injuries (941-949) from 2005-2009. This was further reduced to include those with
an emergency admission and underwent excision of burn wound. Demographic data, total burn surface area (TBSA)
range, comorbidities, surgical data, length of stay, total charges, and mortality were recorded. Included hospital
types were (i) Government, Non-Federal (G); (ii) Private, Not-Profit (PNP) and (iii) Private, Invest-Own (PIO).
Statistical analysis was done with student’s t-test, χ2 test, ANOVA and logistic regression, where appropriate.
Results: A total of 1095 cases were identified. Over a half were treated at a PIO (58%) followed by 29% at PNP
facilities and 14% at G facilities. The table shows the demographics and outcomes of patients undergoing excision
in mean ± SD unless specified as percentage. Length of stay and rate of wound infection among groups were not
significantly different. The highest acuity patients were seen at a PIO facility- TBSA ≥ 20%: G 8%, PNP 5% and
PIO 9%. The single patient with TBSA ≥ 60% was seen at a PIO facility.
Hospital Type
Values
Odds Ratio (95% CI)
p-value
Age
Government, Non-Federal
Private, Not Profit
Private, Invest- Own
53.26 ± 18.52
53.17 ± 19.08
45.60 ± 17.40
<0.001
Government, Non-Federal
Private, Not Profit
Private, Invest- Own
2.57 ± 1.09
2.45 ± 1.01
2.14 ± 0.42
0.004
Government, Non-Federal
Private, Not Profit
Private, Invest- Own
2.52 ± 3.55
2.49 ± 2.92
1.43 ± 4.09
<0.001
Government, Non-Federal
Private, Not Profit
Private, Invest- Own
9.5
12.2
24.1
Government, Non-Federal
Private, Not Profit
Private, Invest- Own
32,209.32 ± 58,585.12
39,764.45 ± 66,164.99
61,947.48 ± 114,949.01
Number of excisions
Time to Operation
Multiple Excisions (%)
Reference
1.327 (0.695-2.534)
3.038 (1.701-5.425)
Total Charges (dollars)
<0.001
Mortality (%)
Government, Non-Federal
0.0
Private, Not Profit
1.3
0.001
Private, Invest- Own
4.6
Conclusions: Burn care is not the same across all hospitals. It appears that PIO facilities are associated with higher
costs, more frequent excisions and mortality. However, this could be a reflection of them also being the facilities to
treat more severely burned patients. Further stratification should be done in attempt to make this determination.