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Plastic surgeon closure in pediatric spine surgery: Comparable outcomes despite greater patient complexity
Victoria Kong1, Andrew Salib1, Joshua Sanchez1
1Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
Insights
Plastic surgeons assist in complex pediatric spine closures, managing medically complex cases without increasing complications or reoperations. This collaboration enhances patient outcomes in specialized reconstructive surgery.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Spine Reconstruction
Background:
- Pediatric spine surgery closure presents unique challenges due to patient factors and high deformity rates.
- Plastic surgeons are increasingly involved, but outcomes data in this population are limited.
Purpose of the Study:
- To evaluate national patterns, outcomes, and safety of plastic surgeon-assisted pediatric spine closure.
- To compare outcomes between plastic and orthopedic/neurosurgical closures in pediatric spine surgery.
Main Methods:
- Retrospective multicenter cohort study using the Pediatric Health Information System database (2000-2025).
- Identification of plastic surgery involvement via specialty codes.
- Comparison of postoperative complications, readmission, reoperation, and length of stay using propensity score matching and adjusted logistic regression.
Main Results:
- 0.8% of 20,903 pediatric spine surgeries involved plastic closure; these patients were more medically complex.
- Plastic surgeon closure was not associated with increased odds of complications (e.g., infection, CSF leak) or reoperations.
- Plastic involvement was independently associated with a longer hospital length of stay (+15.9 days).
Conclusions:
- Plastic surgeons manage highly complex pediatric spine cases effectively.
- Comparable complication and reoperation rates support the integration of plastic surgical expertise in pediatric spine reconstruction.
Purpose:
Pediatric spine surgery closure poses unique challenges owing to smaller body habitus, limited soft-tissue coverage, and high rates of congenital and neuromuscular deformities. Plastic surgeons are increasingly being consulted for complex closures, but outcomes in pediatric populations remain limited to small institutional series. We evaluated national patterns, outcomes, and safety of plastic surgeon-assisted closure.
Methods:
A retrospective multicenter cohort study used the Pediatric Health Information System database (2000-2025) to identify pediatric spine surgeries. Plastic involvement was identified via hospital-reported specialty designation codes. Postoperative complications, 90-day readmission, 90-day reoperation, and length of stay were compared between plastic and orthopedic/neurosurgical closures. Propensity score matching (1:1) balanced demographics, comorbidities, and surgical specialty. Logistic regression with Firth's penalization and Bonferroni correction provided adjusted analyses.
Results:
Among the 20,903 cases, 165 (0.8%) involved plastic closure. These patients were more medically complex, with higher complex chronic condition rates (84% vs. 44%, p < 0.001) and dual neurosurgical-orthopedic involvement (6.1% vs. ≤0.8%, p < 0.001). After matching, plastic surgeon closure was not associated with increased or decreased odds of any complication, including cerebrospinal fluid leak, wound dehiscence, infection, hematoma, or seroma, as well as readmission or reoperation (all padj > 0.05). Plastic involvement remained independently associated with longer hospital length of stay (mean +15.9 days; 95% CI 8.6-23.2; p < 0.001).
Conclusion:
Plastic surgeons manage disproportionately complex pediatric spine cases while achieving complication and reoperation rates comparable to less complex closures, supporting strategic integration of plastic surgical expertise in complex pediatric spine reconstruction.
