Characterization of Factors Leading to Heterotopic Ossification in Adult Burn Injury Using a Large Multi-Institutional Burn Database
Aviram M. Giladi, MD, MS1, Prakash Jayakumar, MBBS2, Lewis Kazis, SD3, Katie Mathews, BA4, Karen Kowalske, MD5, Dagmar Amtmann, PhD6, Jeffrey C. Schneider, MD7, Paul S. Cederna, MD1, Colleen M. Ryan, MD, FACS8, Benjamin Levi, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Boston University, Boston, MA, USA, 4Harvard University Medical School, Boston, MA, USA, 5University of Texas Southwestern, Dallas, TX, USA, 6University of Washington, Seattle, WA, USA, 7Harvard University Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA, 8Massachusetts General Hospital/Shriners Hospital for Children-Boston, Boston, MA, USA.
Purpose: Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study we utilize a novel database of adults with burn injuries to identify and analyze clinical factors that predict HO formation.
Methods: Data from 6 high-volume burn centers, in the Burn Injury Model System, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO.
Results: Of 2,979 patients with information on HO, 98 (3.5%) developed HO. Increasing age increased odds of HO (OR 1.04, p=0.004). Controlling for age and gender, patients with >30% total body surface area (TBSA) burn had 17.5x higher odds of developing HO (p<0.001). Of 98 patients that developed HO, 97 had arm burns (OR 48.3,p<0.001), and 96 had arm grafts (OR 54.9,p<0.001). For each additional time a patient went to the operating room, odds of HO increased 30% (OR 1.28,p<0.001). Ethnicity, contracture, inhalation injury, and bone exposure did not significantly increase odds of HO.
Conclusion: Risk factors for HO development include >30% TBSA burn, arm burns, arm grafts, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments.
|Clinical Factor||Effect on Development of HO|
|Odds Ratio||95% confidence interval||p-value|
|TBSA burn > 30%||17.5*||5.1, 59.6||<0.001|
|Arm Burns (univariate analysis)||48.3*||6.72, 346.9||<0.001|
|Arm Grafts (univariate analysis)||54.9*||13.5, 223.5||<0.001|
|Number of Trips to Operating Room||1.28*||1.18, 1.40||<0.001|
|Inhalation Injury||1.40||0.57, 3.43||0.466|
|Bone Exposure||1.52||0.36, 6.44||0.569|
|Ethnicity (univariate analysis)||1.03||0.89, 1.19||0.716|
Logistic regression results, *significant p≤0.05
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