Thirty-day outcomes after pediatric microtia and anotia reconstruction: A CPT-coded national cohort study

Microtia reconstruction requires balancing short-term safety, operative burden, staging, donor-site morbidity, esthetic goals, hearing needs, and long-term revision risk. However, national data describing early postoperative outcomes across Current Procedural Terminology (CPT)-defined reconstructive phenotypes remain limited.

We performed a retrospective cohort study using American College of Surgeons National Surgical Quality Improvement Program Pediatric data from 2012 through 2024. Children with congenital microtia or anotia who underwent external-ear reconstruction were classified using a prespecified CPT hierarchy into costal-cartilage, prosthetic-associated external-ear, limited-cartilage, or other reconstructive phenotypes. The primary outcome was any 30-day morbidity. Secondary outcomes included wound morbidity, surgical-site infection, un-planned reoperation, readmission, operative time, and length of stay. Multivariable regression, marginal standardization, inverse-probability-of-treatment weighting, stable-capture analyzes, and prosthetic-exclusion sensitivity analysis were used to address measured confounding and test robustness.

Among 2146 children, 1243 (57.9%) were classified as having costal-cartilage, 104 (4.8%) as having prosthetic-associated external-ear, 136 (6.3%) as having limited-cartilage, and 663 (30.9%) as having other reconstructive phenotypes. Mean age was 10.7 years, and 1298 patients (60.5%) were male. Any 30-day morbidity occurred in 103 patients (4.8%), wound morbidity in 99 (4.6%), surgical-site infection in 66 (3.1%), unplanned reoperation in 97 (4.5%), and readmission in 30 (1.4%). After adjustment, no statistically significant morbidity differences were observed across the CPT-defined reconstructive phenotypes. Operative time differed substantially and was the longest in the prosthetic-associated external-ear phenotype.

Pediatric microtia and anotia reconstruction was associated with low 30-day morbidity across CPT-defined reconstructive phenotypes. These data should not be interpreted as establishing equivalence among specific operative techniques. Counseling should be used to emphasize operative burden, staging, donor-site tradeoffs, soft-tissue requirements, hearing needs, esthetic goals, and long-term revision risk.