Purpose <p>Children with severe burns accounts for a considerable proportion of emergency department admissions. Surgical interventions are often indispensable for such pediatric patients. However, healthcare providers may encounter issues such as a high risk of perioperative complications and guardian’s refusal of surgery. This study aims to identify early predictive indicators associated with the number of surgeries, recognize high-risk patients, and provide data support for clinical decision-making.</p> Methods <p>The clinical data of 102 pediatric patients with total burn surface area  ≥ 30% from January 2014 to December 2024 were evaluated. Patients were stratified into three groups based on whether they underwent surgery and the number of surgeries received. The associations among age, gender, cause of injury, total burn surface area, burn index (BI), length of hospital stay, and various laboratory indicators were assessed across the groups.</p> Results <p>Total burn surface area (OR: 1.071, 95% CI 1.015–1.130, <i>P</i> = 0.012), BI (OR: 1.398, 95% CI 1.196–1.635, <i>P</i> = 0.000) and white blood cell (WBC) counts (OR: 1.043, 95% CI 1.004–1.083, <i>P</i> = 0.031) were significantly correlated with the number of surgeries. Total burn surface area (OR: 1.074, 95% CI 1.016–1.135, <i>P</i> = 0.012), BI (OR: 1.376, 95% CI 1.174–1.612, <i>P</i> = 0.000) and WBC counts (OR: 1.045, 95% CI 1.004–1.087, <i>P</i> = 0.031) also emerged as independent risk factors for the number of surgeries for children with severe burns.</p> Conclusion <p>The total burn surface area and BI are associated with the number of surgeries and severity of illness in pediatric patients with severe burns. WBC counts serve as an early adjunctive indicator for surgical burden, though further validation is needed to account for confounding variables. These findings facilitate the rapid identification of high-risk patients who may require transfer to hospital with specialized resources and the development of tailored treatments.</p>