Location, Payer Type, and Gender as Drivers of Burn Scar Reconstruction Utilization: A Burn Model Systems National Database Study

Erin E Ross; Alyssa Bamer; Samuel Mandell; Jeremy Goverman; Barclay Stewart; Haig A Yenikomshian

doi:10.1097/SAP.0000000000004360

Location, Payer Type, and Gender as Drivers of Burn Scar Reconstruction Utilization: A Burn Model Systems National Database Study

Ann Plast Surg. 2025 Apr 15. doi: 10.1097/SAP.0000000000004360. Online ahead of print.

Authors

Erin E Ross¹, Alyssa Bamer², Samuel Mandell³, Jeremy Goverman⁴, Barclay Stewart⁵, Haig A Yenikomshian⁶

Affiliations

¹ From the Keck School of Medicine, University of Southern California, Los Angeles, CA.
² Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
³ Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
⁴ Sumner M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁵ Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA.
⁶ Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

PMID: 40396762
DOI: 10.1097/SAP.0000000000004360

Abstract

Background: There are demographic and socioeconomic disparities in physical and psychosocial outcomes after burn injury. Here, we assess the demographic and geographic variation in utilization of burn scar reconstruction to assess if such barriers to these procedures may be contributing to disparities in outcomes.

Methods: We performed a retrospective cohort study using prospectively collected data from adults enrolled in the Burn Model System National Database between 2015 and 2022. Undergoing burn scar reconstruction, defined as surgery for burn scars or laser scar revision, by 24 months after discharge was compared across age group (18-64 vs 65+ years), gender, race/ethnicity, payer type, and enrollment site. Multiple logistic regression was used to assess use of burn scar reconstruction by demographic characteristics while adjusting for presence of range of motion deficits at discharge, hand burn, head/neck burn, and upper arm/shoulder burn.

Results: In the unadjusted analysis (N = 836), burn scar reconstruction use by 24 months differed by age group (<0.001), race/ethnicity (P = 0.014), payer type (P < 0.001), and enrollment site (P < 0.001). By multiple logistic regression (n = 717), burn scar reconstruction was associated with female sex (odds ratio [OR] 1.89, P = 0.002), workers' compensation (OR 3.41, P < 0.001), enrollment at site 1 or site 2 (OR 6.02, P < 0.001; OR 4.09, P < 0.001), hand burns (OR 2.35, P < 0.001), and upper arm/shoulder burns (OR 2.34, <0.001).

Conclusions: Location, payer type, and gender were primary drivers of burn scar reconstruction use after adjusting for burn characteristics. Geographic variability in burn scar reconstruction use may reflect less dependence on surgery to achieve favorable functional outcomes; however, these differences may represent barriers requiring further evaluation.

Keywords: burn scar reconstruction; contracture; hypertrophic scarring; laser scar revision; surgery access; workers compensation.