Background Social media continues to grow as a relevant information source for the lay public and medical professionals. Methods A search of posts on Facebook and Instagram was conducted using the hashtag #laryngectomy. Posts were categorized based upon perspective, media type, timeframe, topic, tone, and popularity. Results Final analysis included 929 Instagram posts and 355 Facebook posts. Most Facebook posts were made by companies (38%) and physicians (17%) with information (30%) and advertisements (22%) being common topics. Patients (40%) were the largest group of Instagram authors with lifestyle (39%) being the most common topic. Greater than 90% of posts were either neutral or positive in tone across both platforms. Conclusions Patient perspective was most commonly represented on Instagram, whereas Facebook more commonly included posts by physicians and companies. The majority of posts carried a neutral or positive tone, which is consistent with positive quality of life patients have shown postoperatively.

Introduction Despite advancements in burn care, the optimal treatment to prevent or treat hypertrophic scars is still elusive. Therefore, the objective of this study is to compare the efficacy of five glucocorticoid medications commonly used in the treatment of hypertrophic scarring in burned patients using a large patient database. Methods Patients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of skin at least one day after burn injury were identified in the TriNetX database. Hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone were the glucocorticoids investigated. Those who received a glucocorticoid on the same day or any time after the incidence of burn injury were compared to those who did not take glucocorticoids in the previous five years. Patients were stratified into four groups based on percent total body surface area (TBSA) burned: 0-9%, 10-19%, 20-39%, and 40-100%. A total of 165,041 burned patients were found who did not receive glucocorticoids, and 66,652 burn patients who received glucocorticoids after injury. Statistical analysis for comparison included a risk ratio with a significance defined as a p-value < 0.05. Results In all burn patients identified, the risk of hypertrophic scarring diagnosis was reduced with methylprednisolone (RR=0.60, p< 0.001) and prednisone (RR=0.37, p< 0.001), while it was increased with dexamethasone (RR=2.48, p< 0.001). Stratification based on %TBSA burned showed that diagnosis of hypertrophic scarring was reduced in the < 10% TBSA group with methylprednisolone (RR=0.49, p< 0.001) and prednisone (RR=0.33, p< 0.001), while it was increased with dexamethasone (RR=3.6, p< 0.001). Similarly, in the 10-19% TBSA group, the risk was reduced with prednisone (RR=0.57, p=0.024) while increased with dexamethasone (RR=2.2, p< 0.001). No significant effect was observed with hydrocortisone or triamcinolone with any of the %TBSA groups examined. Patients treated with dexamethasone continued to show increased risk for hypertrophic scar diagnosis with 20-39% TBSA (RR=1.69, p< 0.001) and 40-100% TBSA (RR=1.87, p< 0.001). Conclusions While methylprednisolone and prednisone decreased the risk of hypertrophic scarring diagnosis among all burn patients identified, dexamethasone showed an increased risk of hypertrophic scarring diagnosis in all burn patients and in each %TBSA stratified group.

Introduction Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses results in an increased risk of complications. Methods Burned patients were identified using the TriNetX database, a global federated health research network. Fifty-one thousand patients with a diagnosis of cancer prior to experiencing a burn injury were identified. Control groups included 1) patients who had a previous cancer diagnosis and no incidence of burn, and 2) patients who experienced a burn with no history of cancer. Outcomes analyzed included sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression within 5 years. Cancer diagnoses were categorized into 5 of the 13 most common cancer reported in the US. Data was analyzed using a chi-square analysis with p< 0.05 considered significant, and presented odds ratio are with 95% confidence intervals. Results The majority of cancer survivors with burns were White (70%) and female (62%). Compared to cancer patients without burn injury, patients experiencing a burn after a diagnosis of cancer were more likely to develop sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorders (2.569, 2.077-3.177), and depression (1.538,1.468-1.611). When compared to burn patients with no history of cancer, burned patients with cancer diagnosis had increased odds of developing sepsis (3.806, 3.502-4.137), nutritional deficiency (3.529, 2.725-4.571), immunodeficiency (6.657, 5.126,8.645), eating disorder (2.184, 1.787-2.67), and depression (2.147, 2.041-2.259). Further, burned patients with a history of lung cancer experienced a uniquely high risk of sepsis. Additionally, burn patients with histories of either lung or breast cancers were also at increased risk ratios of experiencing depression (p< 0.05). Conclusions Burned patients with a history of a cancer demonstrated considerable increases in complications when compared to those with only a burn injury. Categorization of the broad “neoplasm” label uncovers patterns or trends for specific cancer types to inform the current healthcare system more accurately.

Introduction The use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients. Methods Data was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1st, 1990 and September 19th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant. Results We identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm. Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm. Conclusions The risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

Introduction Bacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time. Methods Burn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions. Results We identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017. Conclusions Species identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.