Convergence of Longitudinal Outcomes after Ablative Fractional CO2 Laser Treatment for Hypertrophic Burn Scars: A 12-Year Comparison Relative to Peers.

Introduction In Western Australia, ablative fractional CO2 laser therapy (AFCO2L) was introduced to treat hypertrophic burn scars (HBS) in 2012. The purpose of this study was to: review the outcomes of the burn patient cohort who received AFCO2L over the first 12 years of the service; and, compare outcomes of those treated with peers not treated with laser. Methods This retrospective cohort study included all patients who received AFCO2L at the Western Australian State Adult Burn Unit between 2012 and 2024. Multidimensional scar outcomes of laser-treated adult burn patients were described and compared with: a timebound cohort including all inpatients and a random selection of 1000 outpatients; and, secondly a group of closely matched peers. Scar and quality of life (QoL) outcomes were analysed for patients who completed a survey package including the Patient and Observer Scar Assessment Scale (POSAS), SF-36, and customised itch questions. Results During the study period, a total of 4005 laser sessions involving 837 individuals were completed. Patients receiving AFCO2L had poorer quality scars at baseline, compared to their peers. From three to six months after burn, the 95% confidence intervals for various and multiple scar, QoL and symptom outcomes of the laser treated patient group overlapped, or converged, with those of the routine care groups. A subset analysis found POSAS scores after only one laser treatment had significant positive changes in itch (p=0.018) and color (p=0.027). Conclusions This study showed that AFCO2L treated patient scar and quality of life outcomes were improved, and converged over time across multiple domains and measures, with those from patients with lower scar burden who were not treated with laser.