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. 2024 Mar;134(3):1214-1219.
doi: 10.1002/lary.30989. Epub 2023 Aug 21.

Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP-P Database

Rahul K Sharma  1 , Nicole G DeSisto  1 , Alexandra S Ortiz  1 , Kelly C Landeen  1 , Shiayin F Yang  1 , Scott J Stephan  1 , Priyesh N Patel  1
Affiliations

Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP-P Database

Rahul K Sharma et al. Laryngoscope. 2024 Mar.

Abstract

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: 3 Laryngoscope, 134:1214-1219, 2024.

Keywords: NSQIP-P; anotia; grafts; microtia; post-operative complications.

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Conflict of interest statement

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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