Effect of distance from burn wound center on follow-up compliance and autograft take success versus standard of care in partial thickness burns presenting from primary emergency departments.

OBJECTIVE: To identify patient variables that may affect post-operative versus standard of care follow-up compliance.

INTRODUCTION: Demographic and social factors affect patient follow-up. In the burn population, follow-up is often associated with improved outcomes. Patient distance from clinic may negatively impact compliance and ultimately, positive autograft outcomes.

METHODS: A prospective burn surgery database was used to obtain demographic and clinical information on patients who underwent first-time skin grafts after burn injury from August 1st, 2021, to December 1st, 2021. Patient characteristics include age, preoperative burn depth, compliance, social factors, and follow-up data from 1 week, 3-week, 1 month and 2 months and wound evaluation. Patient address was used to calculate the distance to the burn surgery clinic.

RESULTS: 232 patients met inclusion criteria. 154 patients underwent a split thickness autograft and 78 underwent standard of care treatment. There were overall less follow-up visits in patients who lived farther from clinic (p=0.0015). The mean number of follow-ups for patient’s 0-25 miles from clinic was 4.6, 26-30 miles from clinic was 4.3 and 31+ miles from clinic was 3.8. In general, auto-grafted patients tended to follow-up more than standard of care patients (4.69 vs. 4.29, p=0.02). At 2-month follow-up, data suggests there is a positive correlation between distance from clinic and percent successful graft take (p=0.0143). There was no statistically significant correlation between percent autograft take and total number of follow-up visits at 1 week. For every mile increase in distance from the clinic, there is a 0.10131 percent increase in compliance at the 2 month follow up visit (p-value 0.0175). Social factors such as private versus public transportation as well as family support contributed to increased compliance.

CONCLUSION: Patients who live further from clinic will often have less robust follow-up. There was no correlation between the number of follow-up visits and percent graft take. The data is inherently biased by the lack of data for patients lost to follow-up. Of the patients who maintained follow-up to 2 months, there appeared to be a trend in increased graft take versus standard of care with increased distance from clinic.