title: Is the length of time in acute burn surgery associated with poorer outcomes?
abstract: BACKGROUND
  Acute wound closure surgery improves outcomes, after burn particularly mortality, but also imposes physiological stress on the patient. The duration of surgery is associated with adverse outcomes in other populations. This study aimed to examine if extended acute burn surgery duration was associated with poorer in-hospital outcomes.
  
  
  METHODS
  This retrospective cohort study included adult burn patients who required a single wound closure surgery at Royal Perth Hospital between 2004 and 2011. Multivariable regression analyses were used to assess the influence of patient and injury factors on surgery duration and length of stay (LOS).
  
  
  RESULTS
  Surgery duration independently increased LOS (incidence rate ratio [IRR]=1.004, p<0.001). This translates to a predicted 13% increase in LOS for a 30min increase in surgery 'knife to skin' time. Total body surface area (TBSA) was identified as a significant predictor of surgery duration (IRR=1.047, p<0.001), estimating that a 10% TBSA increase results in a 59% increase in surgery duration.
  
  
  CONCLUSIONS
  The results show that surgery duration is associated with LOS after adjusting for size of burn and other factors. The study justifies the need to explore strategies to reduce acute burn surgery duration.
authors.affiliation: School of Medicine and Dentistry, University of Western Australia, Australia.
authors.forename: Jolene
authors.initials: J
authors.lastname: Lim
authors.affiliation: School of Medicine and Dentistry, University of Western Australia, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Liew
authors.affiliation: School of Medicine and Dentistry, University of Western Australia, Australia.
authors.forename: Hayley
authors.initials: H
authors.lastname: Chan
authors.affiliation: Fiona Wood Foundation, Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jackson
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Burrows
authors.affiliation: Royal Perth Hospital, Burn Service of WA, Australia; Burn Injury Research Unit, University of Western Australia, Australia; Fiona Wood Foundation, Australia.
authors.forename: Dale W
authors.initials: DW
authors.lastname: Edgar
authors.affiliation: Burn Service of WA, Royal Perth Hospital, Australia; Burn Injury Research Unit, University of Western Australia, Australia; Fiona Wood Foundation, Australia. Electronic address: Fiona.wood@health.wa.gov.au.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
mesh_terms: D000208:Acute Disease; D000328:Adult; D002056:Burns / Q000601:surgery*; D017690:Cell Transplantation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016038:Skin Transplantation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Acute surgery; Autologous cell spray; Length of stay; Theatre time