Timing of surgical excision for burn wounds: A systematic evaluation and meta-analysis comparing early and delayed excision.

BackgroundThe optimal timing of burn wound excision remains controversial. We updated the evidence base by synthesizing data from comparative studies published from 1 January 2010 to 11 March 2024 that compared the outcomes of early and delayed excision in patients with thermal burns.MethodsThe PubMed, Embase, Cochrane Library, and Web of Science Core Collection databases were searched. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Random-effects meta-analysis was performed. Mortality was pooled as risk difference, and continuous outcomes were pooled as standardized mean differences with 95% confidence intervals. Prespecified subgroup analyses considered study design, country income group, and the operational definition of early excision. This systematic review and meta-analysis was formally registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 3 December 2024 (CRD42024621585).ResultsTen comparative studies (8 observational studies and two randomized controlled trials) involving 5070 patients fulfilled the eligibility criteria. Early excision was not associated with lower mortality than delayed excision (5 studies; risk difference: -0.01, 95% confidence interval: -0.06 to 0.03;