Association of total body surface area on effective surgical treatment and mortality in adult burn patients: A 5‑year retrospective analysis in an Indonesian National Referral Hospital

Abstract

OBJECTIVES: This study evaluates the association of total body surface area (TBSA) on surgical treatment outcomes and mortality rates in burn patients.

METHODS: A retrospective cohort study was conducted on adult burn patients admitted to an Indonesian National Referral Hospital from January 2020 to November 2024. Factors associated with mortality, including age, TBSA, and surgery count, were analyzed using the SPSS software version 26.

RESULTS: This study included 595 patients, with a mean age of 41.74 ± 14.95 years and a male predominance (n = 406, 68.2%). Flame or explosion related burns were the most common cause of hospitalization (n = 473, 79.4%). Overall mortality was 42.2%. Surgical activity and length of stay (LOS) increased with TBSA, peaking in the 21%–40% groups (median operations 3 [interquartile range 2–4]), but declined in >40% TBSA due to early deaths. Kaplan–Meier curves confirmed steep survival loss within 2 weeks among >40% TBSA patients (log rank P < 0.001). In multivariable regression, independent predictors of mortality were age (adjusted odds ratio [aOR] 1.021, P = 0.004), male sex (aOR 1.60, P = 0.040), TBSA 31%–40% (aOR 8.27, P = 0.002), and > 40% (aOR 22.3, P < 0.001). Longer LOS (aOR 0.967, P = 0.019) and more operations (aOR 0.737, P < 0.001) were protective. Receiver operating characteristic analysis of numeric TBSA showed good discrimination (AUC = 0.813), with an optimal cutoff at ~ 33.8% (sensitivity 83.7%, specificity 66.3%).

CONCLUSION: TBSA remains the principal driver of burn outcomes, with mortality risk rising sharply beyond ~34%. Early deaths in the largest burn group explain the paradox of fewer operations despite extensive injury.

How to cite this article: Wardhana A, Leksono TP, Sanjaya IS, Handiansyah BS, Farhana N. Association of total body surface area on effective surgical treatment and mortality in adult burn patients: A5‑year retrospective analysis in an Indonesian National Referral Hospital. Turk J Emerg Med 2026;26:94-101.

This study was approved by the Institutional Ethics Committee (KET‑599/UN2.F1/ETIK/PPM.00.02/2024, Protocol No. 24‑04‑0598; and KET‑1676/UN2.F1/ETIK/PPM.00.02/2024, Protocol No. 24‑11‑1679). The requirement for informed consent was waived due to the retrospective design and use of fully anonymized data. Patient confidentiality was strictly maintained, and no identifiable information was disclosed. All procedures were conducted in accordance with institutional guidelines and the principles of the Declaration of Helsinki.

Aditya Wardhana: Conceptualization, study design, data collection, data analysis, and manuscript writing.
Tiara Putri Leksono, Indira Saraswati Sanjaya, Billy Sandy Handiansyah, and Nadya Farhana: Data interpretation, critical revision of the manuscript.
All authors approved the final version of the manuscript and agree to be personally accountable for their own contributions and to ensure the integrity and accuracy of the work.

None Declared.

None.