Determinants of blood loss during primary burn excision

Background. Excisional therapy for burn wounds is frequently associated wit h large operative blood losses. Our objective was to identify patient and o perative factors that affect surgical blood loss arid determine strategies to minimize hemorrhage. Methods. Data from 92 consecutive pediatric patients with severe burns (>40 % total body surface area) were evaluated. Patient demographics, burn chara cteristics, operative factors, and clinical course variables were correlate d with blood loss. Blood loss at the time of initial total burn excision wa s determined by a standardized, previously validated method. Data were anal yzed sequentially arid cumulatively through univariate and cross-sectional multivariate linear regression. Results. Demographic factors that correlated with increased blood loss were older age, male sex, arid large er body size. Area of full-thickness (thir d-degree) burn correlated with blood loss, whereas total burn size did not. High wound bacteria counts (derived from quantitative tissue cultures), to tal wound area excised, and operative time were the strongest predictors of the volume of operative hemorrhage. Blood loss increased with delay to pri mary burn excision at a maximum at 5 to 12 days after burn injury. Conclusions. Early definitive surgical therapy before extensive bacterial c olonization arid rapid operative excision is a strategy that may decrease o perative hemorrhage arid transfusion requirements during burn surgical proc edures.