The impact of location of post-operative care on movement outcomes following single procedure split thickness skin grafting for burn management

Miss Marnie Macfie1, Miss Catherine  Sharpe1, Ms Anita Plaza1, Ms Julie Adsett1

1Royal Brisbane And Women’s Hospital, Brisbane, Australia

Abstract:

After split thickness skin grafts (STSG), patients may be managed as either inpatients or outpatients in the immediate post-operative phase.  Little is known about movement outcomes following management in each of these settings. This study compared mobility and range of motion (ROM) outcomes in patients managed post-operatively in inpatient and outpatient settings at the Royal Brisbane and Women’s Hospital (RBWH).

Methods: A retrospective chart review was conducted of all patients requiring a single procedure STSG to the upper limb (UL) and/or lower limb (LL) between July 2017 and December 2018.  Patients were excluded if they required ICU admission or did not survive to hospital discharge.  Patient characteristics, ROM/mobility commencement times, complication rates, time to achieve full ROM/baseline mobility and costings were compared between inpatients and outpatients.

Results: 304 patients (232 inpatients, 72 outpatients) with a mean TBSA of 13.6% were included.  Compared to inpatients, outpatients were younger (mean age 32 vs 42 years, p<0.001), more likely to be non-smokers (p=0.021) and less likely to have diabetes (1% vs 9%, p=0.013).  Outpatients with LL STSG commenced full weight-bearing mobility earlier (p=0.001) but had significantly greater bleeding complications (p=0.02). Inpatients commenced ROM (p=0.002 UL, p<0.001 LL) and attained full ROM (p=0.045 UL, p=0.004 LL) earlier but incurred significantly greater total healthcare costs (p<0.001). There was no significant difference between groups for mean time to regain baseline mobility.

Conclusion: In this population, ROM outcomes were achieved earlier with inpatient management, however there was no difference between groups for achievement of baseline mobility.


Biography:

Marnie is a physiotherapist at the Royal Brisbane and Women’s Hospital who has worked in both inpatient and outpatient burn management at the Professor Stuart Pegg Adult Burns Centre.

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