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The ratio of hernia size to fascial defect size, termed the hernia-to-neck ratio (HNR), has been proposed as a novel predictive factor for umbilical hernia complications. HNR ≥ 2.5 has been suggested to warrant surgery due to association with bowel strangulation, incarceration, and necrosis. The aim of this study was to evaluate the association between HNR and emergent ventral hernia repair at our institution.A retrospective cohort study was performed of consecutive patients with ventral hernias evaluated at a large safety-net hospital from 2017 to 2019. Patients who required emergent ventral hernia repair were compared to patients who did not require repair at latest follow-up. HNR was calculated using a previously described method: maximal hernia sac size and maximal fascial defect size (termed "hernia neck size") were measured in the sagittal plane on CT scan. Data are described as mean ± standard deviation and median (interquartile range).A total of 166 patients were included: 84 (51%) required emergent hernia repair and 82 (49%) did not undergo repair. Median follow-up was 19 (8-27) months. Patient groups were similar except the emergent repair group had more males (50% vs. 34%, p = 0.03), umbilical hernias (93% vs. 56%, p 0.01), recurrent hernias (31% vs. 15%, p 0.01), and lower mean BMI (34.3 ± 9.9 vs. 39.1 ± 6.5, p 0.01). Hernia sac size did not differ between groups (5.8 [3.8-8.4] cm vs. 6.1 [3.5-11.8] cm, p = 0.45). Hernia neck size was significantly smaller in the emergent repair group (1.5 [2.3-3.5] cm vs. 3.4 [1.8-6.2] cm, p 0.01). Hernia-to-neck ratio was significantly higher in the emergent repair group (2.4 [1.8-3.1] vs. 1.7 [1.1-2.9], p 0.01).This study demonstrated an association between higher HNR and increased risk of emergent ventral hernia repair. Future studies will evaluate the use of HNR to risk-stratify patients with ventral hernias in a safety-net hospital.

Racial and ethnic minority patients experience worse hypertrophic scars after burn injury than White patients. Subsequently, minority patients encounter differences in scar-related recovery domains such as itch and fatigue. This study examines disparities regarding postburn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), outcomes were analyzed at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5D Itch and PROMIS-29 Fatigue measures. Multilevel linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Of 893 total patients, minority patients reported higher/worse itch scores at all time points compared to White patients. Itch scores were significantly higher for Black patients at 6 months (β = 1.42, P = .03) and 12 months (β = 3.36, P < .001) when compared to White patients. Black patients reported higher fatigue scores than White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β = 6.17, P < .001), 6 months (β = 4.49, P < .001), and 12 months (β = 6.27, P < .001) than White patients. This study supports investigation of potential factors leading to increased itch and fatigue such as sociocultural factors, disparities in healthcare access, and psychosocial impacts of these symptoms. In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.

Patients with psychiatric illness and substance use comorbidities have high rates of burn injuries and experience prolonged hospital admissions. This retrospective chart review characterizes this marginalized population’s inpatient burn care and examines post-discharge outcomes compared to burn patients without psychiatric or substance use comorbidities treated at our center. Patients admitted to a single burn center from January 1, 2018 to June 1, 2022 were included. Patient demographics, history of psychiatric disorders, treatment course, and post-discharge outcomes were collected. A total of 1660 patients were included in this study, of which 91 (6%) patients were diagnosed for psychiatric comorbidity and/or substance use comorbidity on admission for burn care. In this cohort of 91 patients with psychiatric and/or substance use comorbidities, the majority of patients were undomiciled (66%) and male (67%). In this cohort, 66 (72%) patients reported recent history or had positive urine toxicology results for illicit substances on admission. In this cohort, a total of 25 (28%) patients had psychiatric comorbidity at the time of burn injury or admission and 69 (76%) patients received inpatient psychiatric care, with 31 (46%) patients requiring psychiatric holds. After discharge, the readmission rate within 1 year of patients with psychiatric and/or substance use comorbidity was over four times greater than that of patients without psychiatric and/or substance use comorbidity. The most common causes of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Our study presents strategies to improve burn care for this marginalized and high-risk population.

During the coronavirus disease 2019 (COVID-19) pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during COVID-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA-verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. Fifty-one patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. Twenty-two (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic, despite a perceived increased risk. Forty-three percentage of patients disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. Seventy-eight percentage of patients agreed or strongly agreed that they felt more susceptible to COVID-19 as burn patients. Eighty-three percentage of patients agreed or strongly agreed that the COVID-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by COVID-19. Patients reported feeling especially vulnerable to the COVID-19 pandemic as burn patients and cited difficulty obtaining care and financial stressors as the main causes.

Introduction Due to stay-at-home and social distancing orders driving the advent of virtual workplaces and classrooms, we hypothesized the COVID-19 pandemic altered the epidemiology of adult and pediatric burn injuries presenting to our large urban burn center. Methods We retrospectively reviewed patients admitted to a metropolitan burn center during a 3-year period: one year prior to the COVID-19 pandemic (Control Year, 3/20/2019 - 3/19/2020) and the first 2 years of the pandemic (Year 1, 3/20/2020 - 3/19/2021; Year 2, 3/20/2021 - 3/19/2022). Data included burn etiology, severity, outcomes, and socioeconomic demographics. Results There were 404 burn patients admitted during the pre-pandemic year (Control Year). Fewer patients were admitted during the pandemic years (Year 1 = 339; Year 2 = 374). The average age of burn patients was similar across the three years (Control Year 39.9 ± 22.6; Year 1 40.4 ± 22.1; Year 2 41.8 ± 21.9 years) with an increasing percentage of males (61%; 68%; 66%) and undomiciled individuals (15%; 19%; 23%) getting burned. Rates of scald, chemical, electrical, and blast burns were similar across years with greater variations in rates of flame (35%; 40%; 37%), contact (5.0%; 8.0%; 3.8%), and friction (0.0%; 0.6%; 1.3%) burns. Survival rates (95%; 94%; 94%) and hospital length-of-stay (11.4 ± 16.5; 11.6 ± 14.4; 12.4 ± 17.7 days) were similar across the 3 years with slightly longer but variable ICU stays during the pandemic (8.2 ± 13.6; 10.1 ± 15.8; 11.5 ± 17.7 days). Conclusions Although the COVID-19 pandemic overwhelmed hospital systems and quarantine measures created altered home environments, our study suggests that burn severity and etiology were not significantly impacted by these changes. However, it does appear that the rate of burn injury decreased during the first year of pandemic lockdowns (Year 1) and started to increase towards pre-pandemic levels by Year 2 as lockdown restrictions were lifted. Flame, contact, and friction burns appeared to increase in frequency during Year 1 but normalized towards pre-pandemic levels by Year 2 as children returned to school. Analysis did show differences in ethnicity which may suggest the possibility of socioeconomic factors impacting who was getting burned during this time, but further studies are required to assess this potential disparity with greater nuance. Applicability of Research to Practice This study improves our understanding of the ongoing impact of pandemic restrictions on burn injuries in cities and may help develop better prevention, education, and intervention strategies.

Introduction Racial and ethnic minority patients may experience worse hypertrophic scar after burn injury than Non-Hispanic, White patients. Consequently, they may encounter differences in scar-related recovery domains including itch and fatigue. We examined disparities in post-burn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. Methods From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), we analyzed outcomes at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5-D Itch and PROMIS-29 Fatigue measures. Multi-level linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Results Of 893 total patients, 149 (17%) patients were Hispanic/Latino, 603 (68%) Non-Hispanic, White, and 86 (10%) Black. Minority patients reported higher/worse itch scores at all time points compared to Non-Hispanic, White patients. Itch scores were significantly higher for Black patients at 6 months (β=1.42, p=0.03) and 12 months (β=3.36, p< 0.0001) when compared to Non-Hispanic, White patients. Black patients reported higher fatigue scores than Non-Hispanic, White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β=6.17, p< 0.0001), 6 months (β=4.49, p=0.0003), and 12 months (β=6.27, p< 0.0001) than Non-Hispanic, White patients. Conclusions This study supports investigation of potential factors leading to increased itch and fatigue such as genomic scar differences, relative treatment effects (e.g., medications, cognitive processing therapy), and psychosocial impacts of these symptoms. Applicability of Research to Practice In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.

Introduction Racial and ethnic minority burn patients often face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database show adult minority patients report worse psychosocial outcomes during burn recovery in domains such as body image or social re-integration. No study to date has investigated differences in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This study examines eight outcomes in minority pediatric patients to better characterize potential differences in the pediatric patient population. Methods Patients under 18 years old treated for burn injury between 2009 and 2019 consented to participate in a multi-center longitudinal study were included in the current sample. We analyzed eight outcomes using the National Institute of Health Toolbox and PROMIS-25 measures with higher reported scores indicating worse symptom severity. Multi-level, linear mixed effects, regression modeling analyzed associations between race/ethnicity and outcomes at three time points (discharge after index hospitalization, 6- and 12- month post-injury. Results The total cohort of 277 patients were 81% male (n = 182) and on average 8.78 years old (range: 3-18 years at time of injury). When surveyed 12 months after injury, pediatric Hispanic patients reported a mean fatigue score of 45.8 (95% confidence interval (CI): 41.6, 49.9) compared to pediatric non-Hispanic patient score of 43.0 (95% CI: 37.1, 48.9). At 12 months, Hispanic patients reported a mean anxiety score of 46.1 (95% CI: 42.7, 49.5), compared to 41.4 (95% CI: 25.8, 47.1) reported by non-Hispanic patients. At 12 months after injury, Hispanic patients reported a mean peer relationship score of 51.1 (95% CI: 47.2, 55.1) compared to non-Hispanic patients' score of 55.5 (95% CI: 50.3, 60.6). Hispanic patients also reported a mean pain interference score of 44.7 (95% CI: 42.3, 47.0) compared to non-Hispanic patients' score of 38.3 (95% CI: 34.9, 41.6) at 12 months after injury. Conclusions Following burn injury, pediatric Hispanic patients report worse outcomes in several psychosocial domains compared to pediatric non-Hispanic patients, although differences were not statistically significant. However, as significant differences in outcomes exist in adult Hispanic/Latino patients, this study supports the need for further evaluation into potential factors that lead to worse outcomes in Hispanic populations. Applicability of Research to Practice Although pediatric Hispanic patients do not report significantly worse outcomes than non-Hispanic patients in short term burn recovery, these patients may benefit from further counseling and psychosocial support after injury.

Introduction Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population. Methods Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected. Results A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Conclusions Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population. Applicability of Research to Practice In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.

Introduction Laser therapy is a growing intervention in hypertrophic scar treatment. This therapy is associated with minimal risks, however these are poorly studied in the burn population. Anecdotal reports of adverse effects such as pain and dyspigmentation exist. As patients, stakeholders, and insurance companies decide on reimbursement for this therapy, a better studied safety profile is necessary. This study is a retrospective review of all laser therapies for adverse events. Methods A retrospective review of patients who underwent laser therapy at two centers between May 2019 and June 2022. Patient demographics, details of laser treatments, adverse events, and scar characteristics before and after laser therapy were collected. Results A total of 167 patients underwent 533 laser treatments. There were 75 (44.9%) males and 92 (55.1%) females, with an average age of 26 (SD: 20.6) years. In total, 94 patients (56.3%) were Hispanic or Latino, 24 (14.4%) Caucasian, and 49 (29.3%) identified as "Other". All patients were treated for hypertrophic scars after burn injuries. For all patients, average number of laser treatments was 3 (SD: 2.2), with a range of 1 to 17 sessions. There were 9 (1.68%) instances of adverse events out of the total laser encounters. There were 5 (0.93%) reports of increased pain, 1 (0.18%) of an open wound, 2 (0.37%) of increased scar discoloration, and 1 (0.18%) of decreased scar pliability. Of the 5 (2.98%) total patients who encountered adverse events, 3 continued with laser therapy. There was no correlation between number of laser treatments and adverse events. Conclusions Patients undergoing laser treatment for burn scar management rarely face adverse events, of which the most common were increased scar pain and dyspigmentation. Even so, most patients experiencing adverse events chose to continue treatments. Laser therapy remains effective in burn scar treatment with minimal risks regarding safety profile. Applicability of Research to Practice This review will assist patients in making more informed decisions when considering laser therapy for burn scar management.

Untreated gastroesophageal reflux disease (GERD) can lead to Barrett’s esophagus and an increased risk for esophageal adenocarcinoma. Magnetic sphincter augmentation (MSA) is a safe and effective modality for the treatment of GERD. Preliminary research on short-term outcomes after MSA demonstrated significant regression of Barrett’s. Further investigation is required to evaluate the long-term effect of this treatment. A retrospective review of patients was conducted with biopsy-proven Barrett’s esophagus who underwent MSA between 2007 and 2019. As a part of their preoperative evaluation, patients underwent esophagogastroduodenoscopy (EGD) with biopsies of the distal esophagus and gastroesophageal junction including any abnormal-appearing segments, pH testing, and a videoesophagram. Patients were categorized according to the length of Barrett’s identified (ultrashort 3 cm). Improvement was defined as a decrease in length (e.g. long to short). There were 87 patients identified for study inclusion. 55 patients were male. The median body mass index was 26.95. The median age was 61.81 (49.79–68.29). Mean follow-up time was 2.35 ± (1.57) years. 7 (8.0%) of these patients began with long segment Barrett’s, 58 (66.7%) began with short segment disease, and 22 (25.3%) began with an ultrashort segment. Within this cohort, 74 (85.06%) had undergone postoperative biopsy. 7 out of 74 patients (9.46%) showed improvement in their intestinal metaplasia and 45/74 (60.81%) showed complete regression. Fisher’s exact test showed a significant decrease in Barrett’s length following MSA (p = 0.002). No patients progressed to dysplasia or neoplasia. There was a statistically significant decrease in the median Demeester score from 34.00 to 13.70 after surgery (p

Recurrence of hiatal hernia after anti-reflux surgery is common, with past studies reporting recurrence rates of 10–15%. Most patients experience relief from GERD symptoms following initial repair; however, those suffering from recurrence can have symptoms severe enough to warrant another operation. Although the standard of care is to revise the fundoplication or convert to magnetic sphincter augmentation (MSA) in addition to redo cruroplasty, it stands to reason that with an intact fundoplication, a repeat cruroplasty is all that is necessary to alleviate the patients’ symptoms. In other words, only fix that which is broken. A retrospective review of patients with symptomatic hiatal hernia recurrence who underwent reoperation between January 2011 and September 2018 was conducted. Patients who received revisional cruroplasty alone were compared with cruroplasty plus some other revision (fundoplication revision, or takedown and MSA placement). Demographics, operative details, and postoperative outcomes were collected. There were 73 patients identified. Median time to recurrence after the first procedure was 3.7 (1.9–8.2) years. Thirty-two percent of the patients had GERD symptoms for more than 10 years. Twenty-six patients underwent cruroplasty only. Forty-seven patients underwent cruroplasty plus fundoplication revision. There were no significant differences in operative times (2.4 h cruroplasty alone, 2.8 h full revision, p = 0.75) or postoperative complications between the two groups. Patients had a mean follow-up time of 1.64 years. Of the 73 patients, 8 had subsequent hiatal hernia recurrence. The recurrence rate for patients with cruroplasty alone was 11%, and the recurrence rate for the full revision group was 12% (p = 1.00). Leaving an intact fundoplication alone at the time of revisional surgery did not adversely affect surgical outcomes. This data suggests a role for hernia-only repair for recurrent hiatal hernias.

Peer support group programs are often recommended for burn survivors as a way to facilitate their psychosocial recovery and reintegration into the community. Such programs provide opportunities for burn patients and their caretakers to access emotional and informational support from healthcare providers and other survivors in inpatient or outpatient settings. Despite their popularity, however, there is little information currently available on the efficacy of these groups. In response, we reviewed the existing literature on peer support group programs and their impacts on psychosocial outcomes for burn survivors and their caregivers. A systematic review of the literature utilizing PubMed, PsycINFO, and Medline databases was conducted for articles published between 1990 and 2018. Twenty-five articles including inpatient, outpatient, integrative peer support groups, and burn camps met our inclusion criteria. All inpatient peer support group program articles (n = 4) reported associations with psychosocial improvements. Integrative peer support group program articles (n = 2) reported associations with social integration and reduction in post-traumatic stress and anxiety. All outpatient peer support group program articles (n = 8) demonstrated associations with psychosocial outcomes involving life satisfaction, acceptance of self, and reduced levels of isolation. Findings were less consistent for burn camps: eight articles suggested improvements in psychological outcomes while three articles reported no significant psychosocial effects. Although these results are encouraging, further study is indicated both to replicate these findings, and to determine the optimal implementation of inpatient and outpatient peer support programs.

Introduction The novel Coronavirus disease 2019 (COVID-19) has created profound challenges in healthcare delivery. Hospital systems have delayed or shut down elective surgeries and outpatient care. These measures resulted in profound disruptions to burn treatment regarding reconstructive care from surgery to therapy. This study aims to characterize burn patients’ perspectives on elective reconstructive surgery during COVID-19. Methods As part of a quality improvement initiative, a 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center during COVID-19 was conducted. Responses regarding willingness to undergo reconstruction during COVID-19, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered over the phone in English and Spanish to burn patients or to primary caregivers in the case of pediatric patients. Results We surveyed 23 participants who met our inclusion criteria. Average age was 23 and 43% were male. We found 22 (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic. Table 1 outlines the responses to questions regarding telehealth and being a burn patient during COVID-19. Examples of stressors experienced by patients and their families due to COVID-19 included: inability to communicate with healthcare providers in person, increased anxiety in public places, delayed surgical care, and interruption of physical or occupational therapy. Family members in 5 out of the 8 Spanish speaking households lost their job due to COVID-19, resulting in financial stress for the burn patient. Conclusions The majority of patients expressed strong desires to return to surgical and therapy care delayed by COVID-19. Patients reported feeling especially vulnerable as burn patients and cited receiving healthcare and financial stressors as a result of the COVID-19 pandemic as the main causes.