Pre-burn malnutrition increases operative mortality in burn patients who undergo early excision and grafting in a sub-Saharan African burn unit

• Published in: Burns 2018-05, Vol.44 (3), p.692-699
• Main Authors: Grudziak, Joana, Snock, Carolyn, Zalinga, Tiyamike, Banda, Wone, Gallaher, Jared, Purcell, Laura, Cairns, Bruce, Charles, Anthony
• Format: Article
• Language: English
• Subjects: Burn mortality; Burn nutrition; Malnutrition; Post-operative burn mortality; Sub-Saharan Africa
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2017.10.003

•Malnutrition is common in children aged 0–5 in our burn unit.•Preexisting Malnutrition increases overall burn mortality.•Pre-existing malnutrition based on z-score increases odds of postoperative burn mortality by 46%.•Attenuating malnutrition prior to operative intervention is imperative In the developed world, pre-existing malnutrition in the burn population influences operative outcomes. However, studies on pre-existing malnutrition and operative outcomes of burn patients in the developing world are lacking. We therefore sought to characterize the burn injury outcomes following operative intervention based on nutritional status. This is a retrospective review of operative patients admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we constructed a fully adjusted logistic regression model of significant predictors of post-operative mortality, both overall and for specific age categories. Of the 1356 admitted patients, 393 received operative intervention (29%). Of those, 205 (52.2%) were male, and the median age was 6 years (3, 25), with 265 patients (67%) aged ≤16 years. The median TBSA was 15.4% (10%–25%) and open flames caused the majority of burns (64%), though in children under 5, scalds were the predominant cause of burn (52.2%). Overall mortality was 14.5% (57 patients) and ranged from 9.09% for patients aged 6–16, to 33.3% for adults ≥50years. Increased time from injury to operative intervention was protective (OR: 0.90, 95% CI: 0.83, 0.99). In post-operative patients with z-scores, increasing %TBSA burned (OR: 1.11, 95% CI: 1.05, 1.17) and increasing malnutrition (OR: 1.46, 95% CI: 1.03, 1.91) predicted death in the adjusted model. Poor nutrition is an important risk factor for post-operative mortality in burned patients in resource-poor settings. Screening for malnutrition and designing effective interventions to optimize nutritional status may improve surgical outcomes in LMIC burn patients.