Dr. Arnold Luterman, Chairman of Surgery, University of South Alabama, Mobile, presented data to show that treatment with collagenase may substantially reduce the cost of care for burn patients.Dr. Luterman
compared outcomes and costs for burn patients treated during 1990-92 and 1994-95 at his
institution.The only difference between the two periods was the introduction of the routine use of collagenase.
The analysis was limited to patients between the ages of 8 and 70 years and whose total body surface burned did not exceed 20%.Patients with inhalation injuries were excluded."We chose this patient population because it represented the most common type of burn seen in burn centers," Dr. Luterman
The Mobile burn center has an excision-based approach to burn management.Within 48-72 hours, a decision is reached about the need for excision, and about 15% of burn patients undergo early excision.The remainder are managed with topical therapy, followed by use of wet and dry dressings.Between 7 and 13 days, a decision is made regarding the need for late excision, and the decision process sometimes extends to 28 days.Patients who do not have late excision are discharged in barrier dressings, accounting for about two-thirds of the patients, said Dr. Luterman
During 1990-92, 407 burn patients met the criteria for the analysis, and 343 met the criteria for 1994-95.Total surface area burned averaged about 6% for patients included from each time period.Collagenase was introduced to the treatment protocol in 1993, and that year was excluded from evaluation.Under the current protocol, use of the ointment begins as soon as edema subsides and continues until the wound clears, said Dr. Luterman
None of the decreases could be explained by the extent of late excision, which did not change, explained Dr. Luterman