Postoperative Surgical-Site Infection Following Burn Injury and Its Impact on Long-Term Survival

Authors:
Lucineia Gainski Danielski

Body of Abstract:
BACKGROUND

Postoperative surgical-site infection is a common complication among burn patients and is associated with increased acute morbidity. However, its long-term clinical and neurocognitive consequences remain poorly characterized. This study evaluated short- and long-term outcomes in burn patients who developed postoperative infection, compared with those without infection, in a large real-world cohort.

METHODS

A retrospective cohort study was conducted using harmonized electronic health record data. Adult patients with burn injuries (ICD-10 T20–T25, T31) were identified and stratified by postoperative infection status (T81.4). Outcomes were assessed at 1-year and 20-year intervals after the index injury. Propensity score matching accounted for demographics, burn severity, and significant comorbidities. Primary outcomes included sepsis-related complications, acute kidney injury (AKI), respiratory failure, delirium, reinfection, and all-cause mortality. Kaplan–Meier survival analyses and hazard ratios (HR) with 95% confidence intervals were calculated.

RESULTS

Postoperative infection was associated with significantly worse outcomes across all time horizons. Within 1 year, infected patients had markedly higher mortality (HR 2.44; 95% CI 1.74–3.41; p=0.022) and increased risk of acute kidney injury (HR 2.07; 95% CI 1.30–3.30; p<0.001). Delirium was more frequent but not statistically significant (HR 1.34; 95% CI 0.85–2.12; p=0.93). Long-term follow-up demonstrated persistently elevated mortality (20-year HR 1.49; 95% CI 1.11–2.01; p=0.007) and higher risk of reinfection (HR 1.77; 95% CI 1.38–2.27; p=0.001) among patients who developed postoperative infection. CONCLUSIONS Postoperative infection following burn injury remains independently associated with increased organ dysfunction, reinfection, and both short- and long-term mortality. These findings underscore the critical need for aggressive infection prevention, early treatment strategies, and long-term surveillance in this vulnerable population.