Microtia Reconstruction: 30-Day Outcomes for Autograft Versus Implant Reconstruction in a National Surgical Database

Abstract

Objective

To compare the use of porous polyethylene implants versus autologous reconstruction for ear reconstruction in patients with microtia or anotia.

Design

Retrospective cohort study.

Setting

Hospitals included in the American College of Surgeons National Surgical Quality Improvement Project—Pediatrics, between 2016 and 2022.

Patients

Children with diagnoses of microtia or anotia.

Interventions

Ear reconstruction utilizing either a porous-polyethylene implant or autologous reconstruction.

Main Outcome Measures

Rates of wound complication, hospital readmission, reoperation, and hospital lengths-of-stay within 30 days of index surgery.

Results

There were 986 patients meeting inclusion criteria, including 893 receiving autograft and 93 receiving synthetic implant. Complication rates, including wound complication, dehiscence, and surgical site infection are similar between the 2 cohorts, though deep surgical site infections are more frequent in patients receiving implant reconstruction.

Patients receiving implant reconstruction have a 4-fold higher odds of hospital readmission and a 9-fold higher odds of reoperation within 30 days after controlling for patient characteristics and surgeon specialty. Patients receiving implant reconstruction also have shorter hospital lengths-of-stay.

Conclusions

Ear reconstruction using autologous cartilage provides better 30-day outcomes compared to implant-based reconstruction with respect to rates of reoperation and readmission. However, these differences may be reflective more of limited surgeon experience with using synthetic implants than of the best possible outcomes achievable with each technique.