Complications With Time-to-Ambulation Following Skin Grafting for Burn Patients: A Meta-Analysis and Systematic Review

Accurate models are fundamental tools for risk-stratification, therapy guidance, resource-allocation, and comparative-effectiveness research. Enhanced recovery after surgery (ERAS) protocols increase early post-operative recovery rates in surgical patients. The uniqueness of burn injuries and their post-operative care requires developing a specialized protocol, enhanced recovery after burn surgery (ERABS). To develop such a protocol, we need to examine post-operative practices, like time-to-ambulation, and their effect on post-operative complications. We evaluated evidence supporting complications such as graft loss, thrombolytic events, and pain, relating to the timing of post-surgical ambulation. A literature search on early-ambulation and skin-grafting was performed by two independent researchers. No time limit was set for publication dates. Relevant studies relating to ambulation of adult burn patients (>18 years of age) and their post-surgical outcomes were captured using search terms. Of the 888 studies retrieved from the query, 11 were used for review and meta-analysis. Our review revealed minimal evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. The evidence that does exist found no significant difference in the number of events between early- and late-ambulation groups. Increased pain during rest and ambulation was shown in patients with delayed ambulation after five or more days. One study found an increased infection rate in late-ambulatory patients. The primary conclusion from this review is that further studies must be performed examining the correlation of thromboembolic events and infection rates with post-operative time-to-ambulation. Based on current literature, early ambulation should be included as part of a future model of ERABS.