title: Timing of early excision and grafting following burn in sub-Saharan Africa.
abstract: BACKGROUND
  This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa.
  
  
  METHODS
  All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011-2014) were studied.
  
  
  RESULTS
  275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7-19) and median total body surface area burn was 15% (IQR, 8-25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p=0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159-0.385) and 0.107 (CI 0.062-0.177) if operated ≤5 and >5 days, respectively (p=0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15-0.79, p<0.000).
  
  
  CONCLUSIONS
  Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.
authors.affiliation: Department of Surgery, University of North Carolina, School of Medicine, CB# 7228, Chapel Hill, NC, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Gallaher
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mjuweni
authors.affiliation: Department of Surgery, University of North Carolina, School of Medicine, CB# 7228, Chapel Hill, NC, USA.
authors.forename: Mansi
authors.initials: M
authors.lastname: Shah
authors.affiliation: North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina, School of Medicine, CB# 7600, Chapel Hill, NC, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Department of Surgery, University of North Carolina, School of Medicine, CB# 7228, Chapel Hill, NC, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina, School of Medicine, CB# 7600, Chapel Hill, NC, USA. Electronic address: anthchar@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D002056:Burns / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D006295:Health Resources; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Burn care in Malawi; Burns in Africa; Early excision and grafting; Global surgery; Operative timing; Timing of burn excision