(161) Risk of Thermal Burns in Electrosurgery: A U.S. cohort study

Background: In monopolar electrosurgery, a pencil-like electrode is used to cut target tissue and/or coagulate bleeding, while a return electrode pad is utilized to retrieve energy that passes through the patient’s body. Thermal burns have been reported from the use of patient return electrodes. These burns can be serious and may lead to a longer hospital stay and scarring. However, the risk of thermal burns during electrosurgery is not yet analyzed in a United States (U.S.) healthcare databases.

Objectives: To estimate the cumulative incidence and 95% confidence interval (CI) of thermal burns among patients undergoing electrosurgeries with use of a patient return electrode between 2016 and 2023 in a large U.S. hospital database, overall and stratified by key characteristics.

Methods: Design and setting: A descriptive cohort study was conducted using electronic healthcare data from the U.S. Premier Healthcare Database. Adult and pediatric patient encounters with a billing charge for a patient return electrode at the index admission between January 1, 2016, and June 30, 2023, were included.
Exposure: Patient return electrode use was defined as a standard charge description containing “cautery” and “pad” during the index admission.
Main outcome measure: Thermal burn was defined as the presence of an ICD-10-CM diagnosis code indicating burns on the body surface during the index admission. No causality attribution between thermal burn and a return electrode device can be assessed from these data.
Statistical analysis: Patient and procedural characteristics were summarized via descriptive analyses. Cumulative incidences and 95% CIs were calculated for thermal burn in the overall population and stratified by key characteristics.

Results: A total of 1,853,015 eligible patients were identified. Most patients were white (70%), female (58%), and had a mean age of 53 (standard deviation: 20) years. The index procedures were mainly performed in an outpatient setting (60%) and were elective (non-urgent; 66%). Overall, 402 patients experienced thermal burn on the body surface during the index admission, and the cumulative incidence was 2.2 per 10,000 patients (95% CI: 1.4-3.2 per 10,000). Similar risk was noted when stratified by all characteristics except for age, where a higher incidence was observed among pediatric patients. In pediatric population, the cumulative incidences were 5.9 per 10,000 (95% CI: 2.2-13.0 per 10,000), 7.1 per 10,000 (95% CI: 3.5-12.6 per 10,000) and 4.8 per10,000 (95% CI: 2.7-8.0 per 10,000) for patients aged < 2, 2-11 and 12-17 years, respectively.

Conclusions: Based on US real-world data, the risk of thermal burn is rare during electrosurgery, and it is highest among pediatric patients.