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Graft loss: Review of a single burn center's experience and proposal of a graft loss grading scale.

MedStar author(s):

Hassan, Lamisa

Johnson, Laura

0022-4804

Name of journal: The Journal of surgical researchAbstract: BACKGROUND: There exists neither a consensus definition of burn "graft loss" nor a scale with which to grade severity. We introduced an institutional scale in 2014 for quality improvement.CONCLUSIONS: Graft loss is a major source of morbidity in burn patients. In this cohort, reoperation was common and hospital LOS was extended. Use of a grading scale improves dialog among providers and enables improved understanding of risk factors. Copyright (c) 2017 Elsevier Inc. All rights reserved.MATERIALS AND METHODS: We reviewed all burned patients with graft loss on departmental Morbidity and Mortality reports between July 2014 and July 2016. Graft loss grades were assigned during the course of clinical care per institutional scale. Chronic nonhealing wounds and nonburn wounds were excluded. Data abstracted included demographics, medical history, injury details, surgical procedures, graft loss, and lengths of stay (LOS). Photos of affected areas were graded by two blinded surgeons, and a linear weighted kappa was calculated to assess interrater agreement.RESULTS: Graft loss was noted in 50 patients, with 43 remaining after exclusions. Mean age was 50.1 y. The majority were male (58.1%) and African American (41.9%). Smoking (30.2%) and diabetes (27.9%) were prevalent. Total body surface area involvement ranged from 0.5% to 51.0% (11.8 +/- 12.3%). Grade I graft loss was documented on one patient (2.3%), Grade II in 15 (34.9%), Grade III in 12 (27.9%), and Grade IV in 15 (34.9%). Reoperation was performed in 20 (46.5%). Hospital LOS was longer than predicted in 38 patients (88.4%). Seven had significant morbidity, including two amputations. Moderate agreement was reached between blinded surgeons (kappa = 0.44, P = 0.004).All authors: Hassan L, Johnson LS, McLawhorn MM, Moffatt LT, Nosanov LB, Shupp JW, Tejiram S, Travis TEFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.jss.2017.05.004

Date added to catalog: 2017-08-23

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	28807206	Available		28807206

BACKGROUND: There exists neither a consensus definition of burn "graft loss" nor a scale with which to grade severity. We introduced an institutional scale in 2014 for quality improvement.

CONCLUSIONS: Graft loss is a major source of morbidity in burn patients. In this cohort, reoperation was common and hospital LOS was extended. Use of a grading scale improves dialog among providers and enables improved understanding of risk factors. Copyright (c) 2017 Elsevier Inc. All rights reserved.

MATERIALS AND METHODS: We reviewed all burned patients with graft loss on departmental Morbidity and Mortality reports between July 2014 and July 2016. Graft loss grades were assigned during the course of clinical care per institutional scale. Chronic nonhealing wounds and nonburn wounds were excluded. Data abstracted included demographics, medical history, injury details, surgical procedures, graft loss, and lengths of stay (LOS). Photos of affected areas were graded by two blinded surgeons, and a linear weighted kappa was calculated to assess interrater agreement.

RESULTS: Graft loss was noted in 50 patients, with 43 remaining after exclusions. Mean age was 50.1 y. The majority were male (58.1%) and African American (41.9%). Smoking (30.2%) and diabetes (27.9%) were prevalent. Total body surface area involvement ranged from 0.5% to 51.0% (11.8 +/- 12.3%). Grade I graft loss was documented on one patient (2.3%), Grade II in 15 (34.9%), Grade III in 12 (27.9%), and Grade IV in 15 (34.9%). Reoperation was performed in 20 (46.5%). Hospital LOS was longer than predicted in 38 patients (88.4%). Seven had significant morbidity, including two amputations. Moderate agreement was reached between blinded surgeons (kappa = 0.44, P = 0.004).

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