Clinical outcomes of bromelain-based enzymatic debridement (NexoBrid®): evidence from the Italian National Burn Database

Background NexoBrid® (bromelain-based enzymatic debridement) has emerged as an alternative to traditional surgical excision in burn management, yet its overall impact on clinical outcomes in large unselected populations remains under discussion. Methods This retrospective study analyzed data from the Italian National Burn Database, including 2238 patients with complete core data treated between 2018 and 2024, to assess the association between NexoBrid® use and major outcomes: survival, escharotomy, skin grafting, number of surgical procedures, and hospital length of stay (LOS). Multivariable regression models were built for each outcome, adjusting for key covariates such as age, burn extent, and inhalation injury. Results Enzymatic debridement did not negatively affect survival compared to standard surgical treatment, confirming its safety in real-world clinical practice. Importantly, enzymatic debridement was independently associated with a significant reduction in the need for escharotomy (OR 0.47, p ' 0.001), reinforcing its established role in managing circumferential burns without decompressive escharotomies. Conversely, NexoBrid®-treated patients showed a higher likelihood of undergoing skin grafting and required more procedures overall, potentially reflecting the need for planned reconstructive care following enzymatic eschar removal. No significant differences were observed in LOS between the two treatment groups. Conclusion These findings confirm the safety of NexoBrid® and its potential procedural benefits, particularly in reducing the invasiveness of early surgical management. While enzymatic debridement may increase surgical workload due to planned grafting, it remains a valuable tool in selected patients. Further prospective research is needed to clarify its long-term functional and resource-related impact, but its role in modern burn care appears increasingly consolidated.