The Use of Non-Autologous Skin Grafts in Adults and Pediatric Burn Patients: A National Study
Alexandra Bucknor1, Patrick Bletsis1, Austin Chen1, Anna Rose1, Winona Wu1, Masoud Malyar1, Sabine Egeler1, Salim Afshar2, Samuel Lin1
1Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Boston Children's Hospital, Boston, MA, USA
Background
This study compares adult and pediatric burns, analyzing the use of non-autologous skin grafts (NASG).
Methods
Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database and National Inpatient Sample Database was undertaken for 2009 and 2012. Demographics, burn specifics and graft details were retrieved using ICD-9 codes (8665 heterograft, 8666 homograft, 8667 dermal regenerative graft). Univariable and multivariable binary logistic regressions were performed to evaluate predictors of NASG use (odds ratios with 95% confidence intervals, CI).
Results
Data for 96,106 inpatient episodes were analyzed: 17,196 (17.9%) pediatric and 78,911 (82.1%) adult. Children had a significantly increased chance of undergoing NASG surgery compared with adults: OR 1.321, CI 1.236-1.413. Other factors increasing the odds NASG surgery were being black (OR 1.176, p<0.001), having private or other insurance compared with government-based insurance (OR 1.254, p<0.001 and OR 1.311, p<0.001), and medium or large bed size hospitals (OR 3.823, p<0.001 and OR 3.643, p<0.001). Burns on the upper limbs (OR 2.445, p<0.001), lower limbs (OR 2.549, p<0.001) or in multiple regions (OR 4.779, p<0.001) increased the odds of NASG surgery, as did increasing burn surface area and the presence of third degree burns (p≤0.001).
Conclusions
The use of non-autologous skin grafts is increased in the pediatric population, in addition to being increased in those with more severe burns. There are racial and socioeconomic differences in the use of non- autologous skin grafts. Further research is needed to evaluate outcomes in these different sub-populations.
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