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Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre

Thomas Jovic, Rebecca Watson Orcid Logo, Sarah Hemington Gorse, Peter J. Drew, Jonathan J. Cubitt

Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume: 88, Pages: 352 - 359

Swansea University Author: Thomas Jovic

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DOI (Published version): 10.1016/j.bjps.2023.11.009

Abstract

Introduction: This study sought to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expense associated with caring for these patients within the burns service.Methods: Patient records were identified with non-burn induced ski...

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Published in: Journal of Plastic, Reconstructive & Aesthetic Surgery
ISSN: 1748-6815
Published: Elsevier BV 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65087
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spelling 2024-10-01T11:01:07.6761746 v2 65087 2023-11-24 Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre 7d95ed2bceb18fc0fdfd4048277c6eed Thomas Jovic Thomas Jovic true false 2023-11-24 MEDS Introduction: This study sought to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expense associated with caring for these patients within the burns service.Methods: Patient records were identified with non-burn induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, dressing clinic records. A cost analysis was conducted using figures from the National Schedule of National Health Service Costs and our own unit-specific costs.Results: 20 patients were identified, with a median age of 46.5 and median TBSA of 30%. The mean length of stay was 21.2 days with 8/20 patients requiring intensive care. Overall mortality was 30%, rising to 50% if patients required ITU admission. Patients had a mean of 1.5 procedures under general anaesthesia and a mean operative time of 169 minutes per patient. Post-operatively, a mean of 8.3 dressing changes were required per patient (range 1-21). 75% of patients were referred as suspected toxic epidermal necrolysis syndrome (TENS) yet, only 32% of patients histologically had TENS (32%), with linear IgA disease, pemphigus vulgaris, and bullous lupus comprising the other diagnoses. Cost analysis predicted a total cost to the unit of £1,422,106.Conclusion: Desquamating dermatological diseases are life-threatening conditions with exhaustive care requirements. Our experiences highlight the importance of awareness of the range of desquamating skin conditions beyond TENS to enable optimum management, and the need to ensure adequate financial provisions to accommodate the care requirements mandated by these patients. Journal Article Journal of Plastic, Reconstructive & Aesthetic Surgery 88 352 359 Elsevier BV 1748-6815 Burns, desquamation, dermatology, service provision 1 1 2024 2024-01-01 10.1016/j.bjps.2023.11.009 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Action Medical Research/ the VTCT Foundation (GN2782) and the Scar Free Foundation/Health and Care Research Wales. 2024-10-01T11:01:07.6761746 2023-11-24T10:59:04.5795099 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science Thomas Jovic 1 Rebecca Watson 0000-0003-1672-8736 2 Sarah Hemington Gorse 3 Peter J. Drew 4 Jonathan J. Cubitt 5 65087__29101__606a12b234184419a771cfd1b481f504.pdf 65087.AAM.pdf 2023-11-24T11:05:09.5894881 Output 752175 application/pdf Accepted Manuscript true Distributed under the terms of a Creative Commons CC-BY Attribution 4.0 Licence. true eng http://creativecommons.org/licenses/by/4.0/
title Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
spellingShingle Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
Thomas Jovic
title_short Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
title_full Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
title_fullStr Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
title_full_unstemmed Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
title_sort Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre
author_id_str_mv 7d95ed2bceb18fc0fdfd4048277c6eed
author_id_fullname_str_mv 7d95ed2bceb18fc0fdfd4048277c6eed_***_Thomas Jovic
author Thomas Jovic
author2 Thomas Jovic
Rebecca Watson
Sarah Hemington Gorse
Peter J. Drew
Jonathan J. Cubitt
format Journal article
container_title Journal of Plastic, Reconstructive & Aesthetic Surgery
container_volume 88
container_start_page 352
publishDate 2024
institution Swansea University
issn 1748-6815
doi_str_mv 10.1016/j.bjps.2023.11.009
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
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description Introduction: This study sought to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expense associated with caring for these patients within the burns service.Methods: Patient records were identified with non-burn induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, dressing clinic records. A cost analysis was conducted using figures from the National Schedule of National Health Service Costs and our own unit-specific costs.Results: 20 patients were identified, with a median age of 46.5 and median TBSA of 30%. The mean length of stay was 21.2 days with 8/20 patients requiring intensive care. Overall mortality was 30%, rising to 50% if patients required ITU admission. Patients had a mean of 1.5 procedures under general anaesthesia and a mean operative time of 169 minutes per patient. Post-operatively, a mean of 8.3 dressing changes were required per patient (range 1-21). 75% of patients were referred as suspected toxic epidermal necrolysis syndrome (TENS) yet, only 32% of patients histologically had TENS (32%), with linear IgA disease, pemphigus vulgaris, and bullous lupus comprising the other diagnoses. Cost analysis predicted a total cost to the unit of £1,422,106.Conclusion: Desquamating dermatological diseases are life-threatening conditions with exhaustive care requirements. Our experiences highlight the importance of awareness of the range of desquamating skin conditions beyond TENS to enable optimum management, and the need to ensure adequate financial provisions to accommodate the care requirements mandated by these patients.
published_date 2024-01-01T08:11:57Z
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