Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis

J Trauma Acute Care Surg. 2015 Nov;79(5):870-6. doi: 10.1097/TA.0000000000000838.


Background: Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation.

Methods: Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO.

Results: Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30% total body surface area burn had 11.5 times higher odds of developing HO (p < 0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p < 0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p < 0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO.

Conclusion: Risk factors for HO development include greater than 30% total body surface area burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments.

Level of evidence: Prognostic study, level III.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Burn Units
  • Burns / complications*
  • Burns / diagnosis
  • Burns / therapy
  • Cluster Analysis
  • Combined Modality Therapy
  • Databases, Factual
  • Disability Evaluation*
  • Female
  • Follow-Up Studies
  • Humans
  • Independent Living
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Ossification, Heterotopic / epidemiology*
  • Ossification, Heterotopic / etiology
  • Ossification, Heterotopic / therapy
  • Prevalence
  • Prognosis
  • Rehabilitation Research*
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Statistics as Topic
  • United States
  • Wound Healing / physiology
  • Young Adult