{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:42:31Z","timestamp":1791499351993,"version":"4.3.4"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>This study evaluates the association of total body surface area (TBSA) on surgical treatment outcomes and mortality rates in burn patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      This study included 595 patients, with a mean age of 41.74 \u00b1 14.95 years and a male predominance (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 406, 68.2%). Flame or explosion-related burns were the most common cause of hospitalization (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 473, 79.4%). Overall mortality was 42.2%. Surgical activity and length of stay (LOS) increased with TBSA, peaking in the 21%\u201340% groups (median operations 3 [interquartile range 2\u20134]), but declined in &gt;40% TBSA due to early deaths. Kaplan\u2013Meier curves confirmed steep survival loss within 2 weeks among &gt;40% TBSA patients (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). In multivariable regression, independent predictors of mortality were age (adjusted odds ratio [aOR] 1.021,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004), male sex (aOR 1.60,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.040), TBSA 31%\u201340% (aOR 8.27,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), and &gt; 40% (aOR 22.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Longer LOS (aOR 0.967,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.019) and more operations (aOR 0.737,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 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%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/tjem.tjem_246_25","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T09:00:12Z","timestamp":1775206812000},"page":"94-101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["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"],"prefix":"10.4103","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7577-8357","authenticated-orcid":false,"given":"Aditya","family":"Wardhana","sequence":"first","affiliation":[{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Burn Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6817-7262","authenticated-orcid":false,"given":"Tiara Putri","family":"Leksono","sequence":"additional","affiliation":[{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Burn Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6616-1657","authenticated-orcid":false,"given":"Indira Saraswati","family":"Sanjaya","sequence":"additional","affiliation":[{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Burn Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3004-3867","authenticated-orcid":false,"given":"Billy Sandy","family":"Handiansyah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Burn Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2332-9808","authenticated-orcid":false,"given":"Nadya","family":"Farhana","sequence":"additional","affiliation":[{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Burn Unit, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"R2-20260414","first-page":"32","article-title":"Bacterial pathogens and antibiotic sensitivity pattern in burn unit of Hasan Sadikin Hospital (RSHS) from January 2012\u2013December 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Cipto Mangunkusumo General Hospital, Indonesia","volume":"6","author":"Hasibuan","year":"2021","journal-title":"New Ropanasuri J Surg"},{"key":"R13-20260414","doi-asserted-by":"crossref","first-page":"216","DOI":"10.4103\/sjmms.sjmms_618_21","article-title":"Mortality and survival analysis of burn patients admitted in a critical care burn unit, Saudi Arabia","volume":"10","author":"Alshammari","year":"2022","journal-title":"Saudi J Med Med Sci"},{"key":"R14-20260414","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1097\/CCM.0000000000000790","article-title":"Morbidity and survival probability in burn patients in modern burn care","volume":"43","author":"Jeschke","year":"2015","journal-title":"Crit Care Med"},{"key":"R15-20260414","doi-asserted-by":"crossref","first-page":"C58","DOI":"10.1152\/ajpcell.00106.2021","article-title":"Burn-induced hypermetabolism and skeletal muscle dysfunction","volume":"321","author":"Knuth","year":"2021","journal-title":"Am J Physiol Cell Physiol"},{"key":"R16-20260414","first-page":"129","article-title":"Surgical options in extensive burns management","volume":"5","author":"Ni\u0163escu","year":"2012","journal-title":"J Med Life"},{"key":"R17-20260414","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/j.burns.2021.07.001","article-title":"Systematic review of excision and grafting in burns:Comparing outcomes of early and late surgery in low and high-income countries","volume":"47","author":"Wong","year":"2021","journal-title":"Burns"}],"container-title":["Turkish Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_246_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:43:59Z","timestamp":1787067839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_246_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/tjem.tjem_246_25","relation":{},"ISSN":["2452-2473","2452-2473"],"issn-type":[{"value":"2452-2473","type":"print"},{"value":"2452-2473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-07-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}