Postburn Outcomes Found to Be Worse in Regular Smokers

CHICAGO — Burn victims who are regular smokers prior to their injuries have poorer outcomes than do nonsmokers, data presented at the annual meeting of the American Burn Association suggest.

In a retrospective analysis of 240 patients, smokers had significantly more surgical procedures than did nonsmokers (1.3 vs. 0.8) and significantly longer hospital stays (13 vs. 9.5 days).

Additionally, smokers had an 85% increased risk of infection during inpatient treatment, said lead investigator Neal Doran, Ph.D., of the University of California, San Diego. The infection rate was 51% in smokers and 36% in nonsmokers, a significant difference.

The study included 80 patients, mean age 35 years, who smoked at least weekly, and 160 nonsmokers, mean age 37 years. The total body surface area burned was similar between smokers (average 7%, range 0.5%-35%) and nonsmokers (average 6%, range 0.3%-36%). The source of burns was flame in roughly 50% of cases, scald in 20%, contact burns in 10%, and chemical, tar, steam, and sunburns in the remainder.

Impaired wound healing, defined as skin graft failure, was not significantly different between smokers and nonsmokers (10% vs. 3%), Dr. Doran said. Impaired wound healing likely was not statistically different between groups because of the relatively few graft failures in either group, and also because graft failure—as a measure of wound healing—represents the extreme negative end of the healing continuum. Still, smokers were almost four times as likely to have graft failure compared with nonsmokers (odds ratio 3.95).

Previous studies have shown that smoking is a significant impediment to wound healing because of the effects of the various chemical components of cigarette smoke such as nicotine, carbon monoxide, and hydrogen cyanide—all of which inhibit oxygen delivery to the wound site.

Because of the longer hospital stays, the cost of treatment was about $3,150 more per smoker, not including the cost of surgeries.

Burn patients are three times more likely to smoke. "When someone has had a health scare, it is an ideal time to provide a motivational intervention intended to change [that person's] behavior," he said.

An audience member observed that 55% of smokers had flame burns and that this uncommon burn pattern results in deeper tissue injuriest that may account for the longer healing times reported among smokers. Dr. Doran responded that the rate of flame burns was not significantly different between the two groups, with 46% of nonsmokers also having flame burns.

Limitations of the study, conducted by Dr. Doran and associates, include the lack of information on the exact number of cigarettes smoked prior to injury and smoking status during hospitalization. Postdischarge outcomes are currently being analyzed.

CHICAGO — Burn victims who are regular smokers prior to their injuries have poorer outcomes than do nonsmokers, data presented at the annual meeting of the American Burn Association suggest.

In a retrospective analysis of 240 patients, smokers had significantly more surgical procedures than did nonsmokers (1.3 vs. 0.8) and significantly longer hospital stays (13 vs. 9.5 days).

Additionally, smokers had an 85% increased risk of infection during inpatient treatment, said lead investigator Neal Doran, Ph.D., of the University of California, San Diego. The infection rate was 51% in smokers and 36% in nonsmokers, a significant difference.

The study included 80 patients, mean age 35 years, who smoked at least weekly, and 160 nonsmokers, mean age 37 years. The total body surface area burned was similar between smokers (average 7%, range 0.5%-35%) and nonsmokers (average 6%, range 0.3%-36%). The source of burns was flame in roughly 50% of cases, scald in 20%, contact burns in 10%, and chemical, tar, steam, and sunburns in the remainder.

Impaired wound healing, defined as skin graft failure, was not significantly different between smokers and nonsmokers (10% vs. 3%), Dr. Doran said. Impaired wound healing likely was not statistically different between groups because of the relatively few graft failures in either group, and also because graft failure—as a measure of wound healing—represents the extreme negative end of the healing continuum. Still, smokers were almost four times as likely to have graft failure compared with nonsmokers (odds ratio 3.95).

Previous studies have shown that smoking is a significant impediment to wound healing because of the effects of the various chemical components of cigarette smoke such as nicotine, carbon monoxide, and hydrogen cyanide—all of which inhibit oxygen delivery to the wound site.

Because of the longer hospital stays, the cost of treatment was about $3,150 more per smoker, not including the cost of surgeries.

Burn patients are three times more likely to smoke. "When someone has had a health scare, it is an ideal time to provide a motivational intervention intended to change [that person's] behavior," he said.

An audience member observed that 55% of smokers had flame burns and that this uncommon burn pattern results in deeper tissue injuriest that may account for the longer healing times reported among smokers. Dr. Doran responded that the rate of flame burns was not significantly different between the two groups, with 46% of nonsmokers also having flame burns.

Limitations of the study, conducted by Dr. Doran and associates, include the lack of information on the exact number of cigarettes smoked prior to injury and smoking status during hospitalization. Postdischarge outcomes are currently being analyzed.

CHICAGO — Burn victims who are regular smokers prior to their injuries have poorer outcomes than do nonsmokers, data presented at the annual meeting of the American Burn Association suggest.

In a retrospective analysis of 240 patients, smokers had significantly more surgical procedures than did nonsmokers (1.3 vs. 0.8) and significantly longer hospital stays (13 vs. 9.5 days).

Additionally, smokers had an 85% increased risk of infection during inpatient treatment, said lead investigator Neal Doran, Ph.D., of the University of California, San Diego. The infection rate was 51% in smokers and 36% in nonsmokers, a significant difference.

The study included 80 patients, mean age 35 years, who smoked at least weekly, and 160 nonsmokers, mean age 37 years. The total body surface area burned was similar between smokers (average 7%, range 0.5%-35%) and nonsmokers (average 6%, range 0.3%-36%). The source of burns was flame in roughly 50% of cases, scald in 20%, contact burns in 10%, and chemical, tar, steam, and sunburns in the remainder.

Impaired wound healing, defined as skin graft failure, was not significantly different between smokers and nonsmokers (10% vs. 3%), Dr. Doran said. Impaired wound healing likely was not statistically different between groups because of the relatively few graft failures in either group, and also because graft failure—as a measure of wound healing—represents the extreme negative end of the healing continuum. Still, smokers were almost four times as likely to have graft failure compared with nonsmokers (odds ratio 3.95).

Previous studies have shown that smoking is a significant impediment to wound healing because of the effects of the various chemical components of cigarette smoke such as nicotine, carbon monoxide, and hydrogen cyanide—all of which inhibit oxygen delivery to the wound site.

Because of the longer hospital stays, the cost of treatment was about $3,150 more per smoker, not including the cost of surgeries.

Burn patients are three times more likely to smoke. "When someone has had a health scare, it is an ideal time to provide a motivational intervention intended to change [that person's] behavior," he said.

An audience member observed that 55% of smokers had flame burns and that this uncommon burn pattern results in deeper tissue injuriest that may account for the longer healing times reported among smokers. Dr. Doran responded that the rate of flame burns was not significantly different between the two groups, with 46% of nonsmokers also having flame burns.

Limitations of the study, conducted by Dr. Doran and associates, include the lack of information on the exact number of cigarettes smoked prior to injury and smoking status during hospitalization. Postdischarge outcomes are currently being analyzed.