Background Long-term psychosocial consequences of burn trauma remain unexplored despite increasing numbers of burn survivors. Evidence suggests that up to 10% of adult burn survivors (mean age of 41.4 years) develop depression, while a substantial proportion report moderate to mild symptoms [1]. Objective To synthesize evidence on interventions for depression in burn patients, evaluate their therapeutic implications, and identify literature gaps to guide future clinical practice, system policy, and trial design. Methods Studies were identified from PubMed, Embase, Web of Science, MEDLINE, and PsycINFO using PRISMA guidelines. Grey literature and manual hand-searches were extracted using the snowball method. Eligible studies were published in English between 1980 and 2025, evaluating depression interventions in burn patients. Title/abstract, full-text screening, extraction, and quality assessment (GRADE criteria) were conducted independently in duplicate, with conflicts resolved by a blinded third author. Heterogeneity precluded meta-analyses, and findings were synthesized qualitatively. Results Our search strategy pulled 1176 articles, of which 13 studies met the study criteria and were categorized into psychosocial (n = 8), pharmacologic (n = 2), and multidisciplinary (n = 3) interventions. Most studies reported reductions in depressive symptoms among participants post-intervention. Conclusion Psychosocial, pharmacologic, and multidisciplinary interventions have the potential to treat depression in burn survivors. Future research needs to prioritize randomized controlled trials, standardized outcome measures, and long-term follow-up to establish robust, evidence-based interventions.

Previous studies have linked preexisting substance use disorders (SUDs) to adverse postoperative outcomes in burn patients, yet their impact on opioid use remains unclear. This retrospective cohort study compares the effects of various substances on opioid use after burns and aims to analyze the risks and whether they differ among substances. The TriNetX database was queried for burn patients aged 18 years and older with preexisting alcohol, cannabis, or tobacco use disorders, who were placed in their respective cohorts. These patients were matched to a nonsubstance use disorder cohort using propensity score matching based on demographics, mental health, pain syndromes, and burn severity. The measured outcomes assessed were opioid use, wound infection, wound disruption, and postprocedural pain. Risk ratios and 95% confidence intervals were calculated at 3 months and 12 months postburn. After matching, patients with preexisting SUDs had significantly higher risk ratios for prolonged opioid use, wound infections, and wound healing disruptions at both 3 and 12 months compared to matched patient control cohorts. Additionally, all patient cohorts also exhibited increased risk of postprocedural pain. Burn patients with preexisting SUDs face a significantly higher risk of prolonged opioid use and postoperative complications at both 3- and 12-month postburn injury. The alcohol cohort patients were associated with the greatest increase in opioid use and postoperative complications, while the tobacco patient cohort presented with the highest wound disruption rates at 3- and 12-months postburn.

Previous literature has highlighted the association between preexisting substance use disorders (SUDs) and adverse postoperative outcomes such as wound infections, postprocedural pain, and wound healing disruptions in burn patients. The impact of preexisting SUDs on prolonged opioid use and postoperative complications remains unclear. We hypothesize that preexisting substance use disorders (SUDs) increase the risk of opioid dependence and contribute to adverse postoperative complications in burn patients. This retrospective cohort study evaluates the effect of alcohol, cannabis, and tobacco SUDs on long-term opioid use and postoperative complications in adult burn patients. The TriNetX database was queried to identify adult burn patients (aged 18+) with preexisting diagnoses of alcohol, cannabis, or tobacco SUDs who sustained burn injuries. Patients were matched to a non-SUD cohort based on demographics, mental health conditions, pain syndromes, and burn severity using propensity score matching. Outcomes measured included prolonged opioid use and postoperative complications, such as wound infections, postprocedural pain, and wound healing disruptions. Risk ratios (RR) were calculated at 90 days and 1-year post-injury. Statistical significance was set at p < 0.05. Before matching, 24,940 alcohol SUD, 20,274 cannabis SUD, and 77,543 tobacco SUD patients were identified with burn injuries. After matching, SUD patients had significantly higher risk ratios for prolonged opioid use at 90 days (Alcohol: RR 1.899, Cannabis: RR 1.832, Tobacco: RR 1.568) and 365 days (Alcohol: RR 1.798, Cannabis: RR 1.650, Tobacco: RR 1.581) compared to non-SUD patients. Similarly, the risk of wound infections was elevated at 90 days (Alcohol: RR 3.702, Cannabis: RR 2.864, Tobacco: RR 2.157) and 365 days (Alcohol: RR 2.452, Cannabis: RR 2.144, Tobacco: RR 1.898). SUD patients also exhibited increased risk of postprocedural pain at 90 days (Alcohol: RR 2.122, Cannabis: RR 2.307, Tobacco: RR 1.636) and 365 days (Alcohol: RR 1.761, Cannabis: RR 1.802, Tobacco: RR 1.578), as well as higher risks for wound healing disruptions at 90 days (Alcohol: RR 2.472, Cannabis: RR 2.906, Tobacco: RR 1.752) and 365 days (Alcohol: RR 2.001, Cannabis: RR 1.897, Tobacco: RR 1.555). All findings were statistically significant (p < 0.005). Burn patients with preexisting SUDs face a significantly higher risk of prolonged opioid use and postoperative complications. Burn patients with preexisting alcohol-related disorders showed the most significant increase in opioid use. Cannabis use was associated with the highest rate of postoperative complications at 3 and 12 months after burn. Personalized pain management and targeted SUD treatment protocols for burn patients are essential for mitigating opioid dependence, reducing the likelihood of complications, and enhancing long-term recovery outcomes. Supported by UTMB Institute for Translational Sciences (UL1 TR001439), funded by the National Center for Advancing Translational Sciences at the NIH.

Preoperative assessments typically center on ensuring patient safety, surgical readiness, and evaluating medical history alongside potential anesthesia and surgical risks. Burn severity profoundly influences surgical timing, complexity, anesthesia considerations, and postoperative care needs. Post-operative complications among burn patients include hypothermia, acute kidney injury (AKI), and cardiac arrest related to hypovolemic shock. This improvement aims to align anesthesia staffing and postoperative care allocation to optimize burn patient outcomes through the development of a Pre-Operative Burn Risk Level Assessment Tool. Risk levels were determined by inpatient acuity considerations, Total Body Surface Area (TBSA) burn, and abnormal findings. Low risk: routine burn operation, TBSA ≤ 20%, or no abnormal findings. Moderate risk: first burn operation, past perioperative adverse event, TBSA 20-40%, or stabilized abnormal findings. High risk: operation ≤ 48 hours post-burn, TBSA > 40%, or unstabilized abnormal findings. Anesthesia staffing: low risk – standard; moderate risk – one faculty anesthesiologist to two patients, one mid-level resident to one patient; high risk – one faculty anesthesiologist to one patient, one upper-level resident to one patient. Post-operative disposition: low risk – PACU; moderate risk – ICU or PACU based on intra-operative response; high risk – ICU. A total of 63 surgical cases were reviewed over the course of 6 months. Risk level underscoring occurred in 5 surgical cases, though patient disposition and anesthesia staffing were maintained at the higher level. Inappropriate staffing and patient disposition discrepancies relative to risk level each occurred separately in 1 surgical case. All surgical cases were executed without untoward incidents. Risk level determination and communication were integrated into the electronic surgical posting process. This initiative necessitated adjustments in anesthesia faculty ratios and assignments based on resident experience. Moderate risk level criteria slightly increased the number of patients returning to the ICU for post-operative care. Both departments effectively managed changes without increasing their staffing levels. Implementation of the Pre-Operative Burn Risk Level Assessment Tool has led to a decrease in post-operative safety events among burn patients. A quality improvement project to reduce the occurrence of post-operative burn patient safety events by designating and communicating a pre-operative burn risk level. N/A

There is an unacceptably high burden of death and disability from conditions that are treatable by surgery, worldwide and especially in low- and middle-income countries (LMICs). The major actions to improve this situation need to be taken by the surgical communities, institutions, and governments of the LMICs. The US surgical community, including the US academic surgical community, has, however, important roles to play in addressing this problem. The American Surgical Association convened a Working Group to address how US academic surgery can most effectively decrease the burden from surgically treatable conditions in LMICs. The Working Group believes that the task will be most successful (1) if the epidemiologic pattern in a given country is taken into account by focusing on those surgically treatable conditions with the highest burdens; (2) if emphasis is placed on those surgical services that are most cost-effective and most feasible to scale up; and (3) if efforts are harmonized with local priorities and with existing global initiatives, such as the World Health Assembly with its 2015 resolution on essential surgery. This consensus statement gives recommendations on how to achieve those goals through the tools of academic surgery: clinical care, training and capacity building, research, and advocacy. Through all of these, the ethical principles of maximally and transparently engaging with and deferring to the interests and needs of local surgeons and their patients are of paramount importance. Notable benefits accrue to US surgeons, trainees, and institutions that engage in global surgical activities.