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Porous Polyethylene Versus Autologous Costochondral Reconstruction for Microtia: Incidence and Analysis of Secondary
Kaamya Varagur1, Ema Zubovic1, Gary B Skolnick1
1Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Objective:
To examine the frequency of autologous and alloplastic ear reconstructions for patients with microtia in the United States, and describe post-index procedure rates associated with each method.
Design:
Retrospective cohort study.
Setting:
Claims data from 500 + hospitals from IBM® MarketScan® Commercial and Multi-State Medicaid databases.
Patients/Participants:
A total of 649 patients aged 1 to 17 years with International Classification of Diseases, ninth/tenth revision (ICD-9/10) diagnoses for microtia, congenital absence of the ear, or hemifacial microsomia.
Interventions:
Alloplastic or autologous ear reconstruction between 2006 and 2018.
Main Outcome Measure:
Post-index procedures performed within 1 year following the index repair, analyzed across the study period and separately for each half of the study period (2006-2012, 2012-2018).
Results:
A total of 486 (75%) qualifying patients received autologous and 163 (25%) received alloplastic reconstruction. Secondary procedure rates were significantly higher in the autologous group at 90 days (P = .034), 180 days (P < .001), and at 365 days (P < .001). Alloplastic reconstruction accounted for 23.2% of reconstructions in the first half of the study period compared with 26.7% in the second half (P = .319). One-year secondary procedure rates in the autologous group were not significantly different between both halves of the study period (69.7% vs 67.1%, P = .558), but were significantly lower in the second half for the alloplastic group (44.9% vs 20.2%, P = .001).
Conclusions:
In these databases, autologous reconstruction is more common than alloplastic reconstruction. Autologous reconstruction is staged, with most undergoing a secondary procedure between 3 months and 1 year postoperatively. Secondary procedure rates decreased over time in patients undergoing alloplastic reconstruction.
Insights
Autologous ear reconstruction is more common than alloplastic reconstruction for microtia. However, alloplastic methods show decreasing secondary procedure rates over time, suggesting improved outcomes.
Area of Science:
- Plastic Surgery
- Otolaryngology
- Health Services Research
Background:
- Microtia, a congenital ear deformity, requires surgical reconstruction.
- Both autologous (tissue-based) and alloplastic (implant-based) methods are used for ear reconstruction.
- Understanding the comparative frequency and outcomes of these methods is crucial for patient care.
Purpose of the Study:
- To compare the frequency of autologous versus alloplastic ear reconstructions in pediatric patients with microtia in the U.S.
- To analyze and describe the rates of post-operative procedures associated with each reconstruction method.
Main Methods:
- Retrospective cohort study utilizing claims data from over 500 hospitals (IBM MarketScan).
- Included 649 patients aged 1-17 with diagnoses of microtia, congenital ear absence, or hemifacial microsomia.
- Analyzed alloplastic or autologous ear reconstruction procedures performed between 2006 and 2018, focusing on secondary procedures within one year.
Main Results:
- Autologous reconstruction was performed in 75% of patients, while alloplastic reconstruction was used in 25%.
- Secondary procedure rates were significantly higher for autologous reconstruction at 90 days, 180 days, and 365 days post-surgery.
- While alloplastic reconstruction use remained stable, its one-year secondary procedure rate significantly decreased in the latter half of the study period.
Conclusions:
- Autologous reconstruction is currently more prevalent for microtia repair in the studied population.
- Patients undergoing autologous reconstruction frequently require staged procedures, with most needing a secondary surgery within a year.
- Alloplastic reconstruction shows a trend towards improved outcomes with decreasing secondary procedure rates over time.
