Objectives
Bromelain based enzymatic debridement is an accurate and fast modality to debride buns but its indication in patients older than 65 is still controversial. The aim of the study was evaluate the efficacy of the debridement in older patients and compare its results to an historical cohort of patients treated with the standard of care.



Methods
A retrospective study was developed. Patients treated between 2015 to 2017 older than 65 y.o. and with less than 15% TBSA were collected. The control group was designed with an historical cohort from 2013 and 2014 when enzymatic debridement was not approved in our country. Both groups were homogeneous for TBSA, age, sex and inhalation syndrome. Epidemiological figures, length of stay, number of interventions and mortality was recorded. Statistical evaluation were done using U Mann Whitney and x2 tests from SPSS 21.0 Software.



Results
80 patients were enrolled in the study, and divided in two groups: 60 controls and 20 cases. Average TBSA was 6.37%, with a mean age of 78,1 y.o. The mortality ratio was 10%, with same mean values for both groups. The time to complete debridement was 6,77±7,4 days in the control group vs 2,15±1,7 days in the experimental group. The average number of surgical interventions in the control group was 1,47±0,74 and 0,75±0,71 in the Nexobrid group. Despite these advantages, the length of stay were not statistically signficant, with 17,43±13,3 days in the control group and 19,65±11,77 days in the experimental one.



Conclusion
Bromelain based enzymatic debridement allows to reduce the number of surgeries over older patients, reducing the time until complete debridement of burns. No impact over length of stay was demostrated in this study.

6 - Efficacy of enzymatic debridement over elderly patients