622 Enhanced Recovery After Surgery for Fractional CO2 Laser Treatment of Burn Scars

Abstract

Introduction Healthcare systems have adopted enhanced recovery after surgery (ERAS) programs as evidence-based, multimodal, and multidisciplinary perioperative approaches to mitigate complications and improve early recovery. ERAS programs modify psychological and physiological response to surgery with standardized care pathways that range from preoperative assessment and education through pharmacologic and surgical interventions. Our study demonstrates a burn scar specific ERAS protocol with pre- and post- intervention outcomes. Methods As part of a quality and performance improvement initiative, a multidisciplinary panel at an ABA-verified burn center consisting of burn nurses, burn surgeons, burn physician assistants, burn therapist, clinical pharmacist, certified medical laser safety officer, and anesthesiologist reviewed the available literature regarding pain, laser treatments, and medication histories of prior fractional CO2 laser treatments. The ERAS program was designed with preoperative, perioperative, and postoperative interventions to reduce pain and complications defined as unscheduled visits/admission to the ER or burn center, narcotic administration >1 hour post procedure, or wound complications secondary to laser treatment requiring dressing changes >1 week post-procedure. Quality and performance metrics were collected as a component of the burn registry program and reviewed twice monthly. The ERAS protocol preoperative phase included standardization of outpatient screening, assessment, and electronic medical record documentation. The perioperative phase included standardization of preprocedural medications including multimodal analgesia. The intraoperative phase included standardization of medications and dressing application. Post procedural phase included standardized instructions for wound care and follow-up. Results Pre-implementation complications over a three-month period included one patient requiring wound care >1 week post laser treatment and 4 patients requiring narcotic administration >1 hour post procedure (16% of laser cases). Post-implementation of the ERAS program no complications were identified in 62 cases over a three-month period. Conclusions At our institution a burn scar specific ERAS protocol reduced perioperative complications following fractional CO2 laser procedures. While many opportunities exist to improve scarring and pain, the multidisciplinary approach in burn care is as essential for outpatients as it is for inpatients at reducing avoidable complications.