Ablative fractional resurfacing for burn scar management: Effect on number and nature of elective surgical reconstructive procedures and hospital length of stay

Dr Andrea C Issler-Fisher1,4,5, Dr Oliver M Fisher2,3, Dr Nicola Clayton1, Dr Shivani Aggarwala1,4, A/Prof Peter Haertsch1,4, Dr Zhe Li1,4,5, Prof Peter Maitz1,4,5

1Concord Repatriation General Hospital, Concord, Australia, 2Department of Surgery UNSW, St. George Hospital, Kogarah, Australia, 3Department of Surgery, University of Notre Dame, Sydney, Australia, 4University of Sydney, Camperdown, Australia, 5ANZAC Research Institute, Concord Repatriation General Hospital, Concord, Australia


Purpose. To investigate the impact of ablative fractional CO2 laser (AFL) on burn case-mix, hospital length of stay (LOS), and anaesthetic times.
Methods. The nature and number of elective reconstructive procedures pre- and post-AFL era at the Burns Unit of Concord Repatriation General Hospital (CRGH) was analysed from 2013 to 2017.
Results. 412 elective procedures (251 AFL) were analysed. The proportion of non-laser reconstructive procedures dropped dramatically following AFL introduction, with initially 47.4% of procedures being non-AFL in Q1 of 2015 to only 10.1% in Q1 of 2017. This affected LOS, with average LOS being 2.3 days pre-laser and 0.66 days post-laser (p<0.001), and mean LOS being 1.7 days for non-laser and 0.05 days for AFL-procedures (p<0.001). Equally, anaesthetic times decreased, with median duration being 90mins pre-laser and 64mins post-laser (p<0.001), and median anaesthetic times being 87mins for non-AFL and 57mins for AFL procedures (p<0.001).
Conclusion. AFL affects elective reconstructive burn case mix, with a replacement of conventional reconstructive operations with AFL-procedures. This results in a reduction in average LOS and average anaesthetic times. Consequently, it is anticipated that overall costs associated with elective burn scar reconstruction may decrease with increased use of AFL in burn and reconstructive surgery.


Following training in general surgery, burns & plastic surgery in Switzerland, Dr Issler-Fisher joined the Sydney University Burns Unit of Concord Repatriation General Hospital (CRGH) in Sydney in 2013, where she established and now runs the Burns Scar Clinic in 2015.

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