Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP‐P Database
Rahul K. Sharma, Nicole G. DeSisto, Alexandra S. Ortiz, Kelly C. Landeen, Shiayin F. Yang, Scott J. Stephan, Priyesh N. Patel - Otorhinolaryngology
Objectives
Microtia and anotia repair require techniques that consider both aesthetics and function. The outcomes of different reconstructive frameworks such as costal cartilage or a porous polyethylene implant have not been evaluated on a national scale. We aim to understand differences in outcomes/complication rates and operative times between different reconstructive frameworks used in microtia/anotia reconstruction.
Methods
This was a retrospective review of the National Surgical Quality Improvement Program Pediatric database between 2012–2019. Patients with ICD‐9/10 codes for microtia/anotia were isolated. Reconstruction methods were identified using CPT codes for rib graft, ear cartilage graft, and alloplastic implants (biocompatible implants, porous polyethylene, etc). Outcomes included operative‐time, wound complications, and unplanned re‐operations within 30 days of surgery. Multivariable logistic regression was performed to control for confounders.
Results
We included 593 patients for analysis. Reconstruction with rib grafts (N = 506, 85%) was the most common. In 58 patients (9.8%), an implant was used for the auricular framework, whereas in 47 (7.9%) ear cartilage grafts were used. The overall wound complication rate was 3.4%. On univariate analysis, alloplastic implants exhibited a higher rate of wound complications (8.6% vs. 2.8%, p = 0.037) and longer operative times (350 min vs. 235 min, p < 0.001). After controlling for demographics and comorbidities, implants conferred an independently increased risk of wound complications (OR 3.52, 1.10–9.54, p = 0.020).
Conclusion
Although the use of alloplastic implants (e.g., porous polyethylene) may confer an increased risk of early complications, the long‐term clinical implications of these findings are unclear relative to aesthetic benefits. Multi‐institutional studies are needed to validate these findings using patient‐specific and surgeon‐specific data.
Level of Evidence
III Laryngoscope, 2023