Bridging Acuity and Anesthesia: A Novel Tiered Framework for Anesthetic Stratification in Operative Burn Management

Abstract

Burn injuries vary widely in clinical severity, operative complexity, and physiologic burden. Although scoring systems exist for predicting morbidity and mortality in burn patients, a standardized framework for coordinating burn case acuity with anesthesia expertise has yet to be implemented in clinical practice. In this retrospective, single-center study, we analyzed 132 operative burn cases performed over a one-year period to evaluate a novel tiered classification system that stratifies anticipated anesthesia requirements by clinical severity. Cases were categorized as Green (low risk), Yellow (moderate risk), or Red (high risk) based on physiologic risk factors, including burn extent as percentage of total body surface area (TBSA), hemodynamic instability, and vasopressor dependence. Patient demographics and clinical variables, including age, mechanism of injury, TBSA, and intraoperative transfusion requirements were collected and statistically analyzed. Results showed that the pediatric cohort (<18 years old) demonstrated significantly greater mean TBSA burns (43.3% vs. 21.8%, p=0.0017, 95% CI [-33.70, -9.00]) and represented a higher proportion of Red-tier (high-risk) cases than adult patients (p=0.0011), with a similar mechanism of injury observed across cohorts (p=0.50). A statistically significant difference was observed in the distribution of intraoperative blood product administration across severity tiers (p<0.001). The findings of this study suggest that the proposed tiered system identifies clinically distinct groups of operative burn cases based on injury severity and physiologic instability. We propose that implementing this framework in clinical practice may improve outcomes for patients with acute burns, facilitate more efficient allocation of anesthesia resources, and guide standardized educational structures for management of acute burn injuries.