Early Surgery and Outcomes in Severe Burns

OBJECTIVE: To examine the association between the timing of surgical excision and survival in severely ill burn patients. SUMMARY BACKGROUND DATA: The optimal timing of surgical excision in severe burns remains uncertain. Early excision may limit systemic inflammation but may also increase hemodynamic instability. METHODS: This prospective, multicenter, observational cohort study (December 2016-December 2022) included adults (18 y of age or older) admitted within 72 hours of injury with burns involving >20% TBSA across 6 French centers. Early surgery was defined as the first excision within 48 hours. The primary outcome was 90-day all-cause mortality. Secondary outcomes included ICU and 28-day mortality, organ failure, acute kidney injury, ARDS, secondary infections, sepsis, and ICU length of stay. Associations were estimated using AIPTW and targeted maximum likelihood estimation. RESULTS: Among 448 patients (median age 47 y; 65% male; median TBSA 33%), 90 (20%) underwent early and 358 (80%) delayed excision. Early-excision patients had more extensive burns and higher severity scores. After adjustment, delayed excision was associated with higher 90-day mortality (aOR: 2.3, 95% CI: 1.2-4.1; P=0.007), higher ICU mortality (aOR: 3.1, 95% CI: 1.5-6.3; P=0.001), and higher 28-day mortality (aOR: 2.9, 95% CI: 1.3-6.7; P=0.007). Sepsis or septic shock occurred more often in the early group (53% vs. 32%; aOR: 0.56, 95% CI: 0.38-0.83; P=0.004). No significant differences were found for other secondary outcomes. CONCLUSIONS: Early surgical excision within 48 hours was associated with lower adjusted 90-day mortality in adults with severe burns, supporting early excision as part of modern burn management strategies.