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Pediatric Otoplasty: Does Surgical Specialty Training Affect Safety and Rates of Adverse Perioperative Events?
Christopher L Kalmar1, Vijay A Patel2, Laura S Humphries1
1Children's Hospital of Philadelphia.
Insights
Otoplasty is a safe procedure for ear correction, with low complication rates regardless of surgical specialty. Specific patient factors like prematurity and seizure disorders are linked to rare reoperations or readmissions.
Area of Science:
- Plastic Surgery
- Otolaryngology
- Pediatric Surgery
Background:
- Otoplasty is a common procedure performed by both plastic surgeons and otolaryngologists.
- Analyzing otoplasty safety and identifying risk factors for patient morbidity is crucial.
Purpose of the Study:
- To objectively analyze the safety of otoplasty.
- To determine if surgical training or other risk factors are associated with increased patient morbidity.
Main Methods:
- Retrospective cohort study of 777 pediatric otoplasty procedures (2012-2017).
- Data sourced from the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset.
- Statistical analysis to assess relationships between comorbidities, congenital malformations, and postoperative complications.
Main Results:
- No significant difference in postoperative complications between plastic surgeons and otolaryngologists.
- Superficial surgical site infection was the most common complication (0.9%).
- Comorbidities and congenital malformations were not associated with increased complications, but prematurity, pulmonary, alimentary, and seizure disorders correlated with reoperation/readmission.
Conclusions:
- Otoplasty demonstrates low complication and readmission rates, with comparable safety between plastic surgery and otolaryngology specialties.
- Surgical site infection is the primary complication.
- Specific patient risk factors significantly correlate with adverse events like readmission and reoperation.
Background:
Otoplasty remains an overlapping clinical domain of plastic surgery and otolaryngology. The purpose of this study is to objectively analyze the safety of otoplasty and determine if there are any risk factors, such as surgical training, associated with increased patient morbidity.
Methods:
Retrospective cohort study was conducted of otoplasty procedures performed in North America by plastic surgeons and otolaryngologists between 2012 and 2017 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset. Statistical analysis was performed to analyze the relationships between comorbidities, congenital malformations, and postoperative complications.
Results:
There were 777 otoplasty procedures performed during the study period. Median age at time of surgery was 8.3 years (95% CI 7.9-8.7 years). Plastic surgeons performed 75.8% (n = 589) procedures and otolaryngologists performed 23.4% (n = 182). No significant (P = 0.952) difference in the occurrence of postoperative complications between surgical specialties was appreciated despite the fact that operative time was significantly longer in procedures performed by otolaryngologists (121 minutes versus 94 minutes, P < 0.001). Overall, 1.3% (n = 10 of 777) children experienced a complication, with the most common complication being superficial surgical site infection, occurring in 0.9% (n = 7 of 777) patients. There was no association of comorbidities (P all > 0.324) or congenital malformations (P all > 0.382) contributing to postoperative complications. Reoperation (0.8%, n = 6 of 777) and readmission (0.4%, n = 3 of 777) were uncommon; nevertheless, these adverse events were significantly associated with multiple inherent patient risk factors on multivariate regression.
Conclusions:
Otoplasty is a relatively safe surgical procedure with similarly low complication and readmission rates when performed by plastic surgeons and otolaryngologists. Surgical site infection remains the most prevalent complication after otoplasty. Readmission and reoperation after otoplasty were significantly correlated to prematurity, structural pulmonary abnormality, alimentary tract disease, and seizure disorder.
