Pediatric Tissue Expansion: Analysis of the National Surgical Quality Improvement Program–Pediatric

Abstract

Introduction: Tissue expansion (TE) in pediatric surgery provides vascularized tissue to attain functional and esthetic goals in a broad range of reconstructive procedures. Our study evaluates the demographic, operative, and short-term outcomes of TE in pediatric patients utilizing the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database and highlights factors associated with postoperative complications. Materials and Methods: Retrospective review of a large multicenter database of 402 pediatric patients that underwent TE within the NSQIP-P database from 2013 to 2020 at freestanding general acute care children's hospitals, children's hospitals within a larger hospital, specialty children's hospitals, or general acute care hospitals with a pediatric wing. Patient demographics, clinical risk factors, operative information, and postoperative outcomes were collected with an odds ratio analysis of risk factors. Results: Patients were majority female (55.5%), White (63.2%), and non-Hispanic (67.4%). The minority were born prematurely (11.9%) and had congenital malformations (16.7%). Complications occurred in 5.7%, unplanned readmission in 4.5%, and unplanned operation in 6.5% of patients. Complications lead to readmission in 2.5% and return to the operating room in 3.2% of patients. American Society of Anesthesiology (ASA) score III-IV, congenital malformations, > 1-day hospital stay, and pulmonary, neurologic, and hematologic comorbidities were associated with the greatest increase in odds of complication. Conclusion:This study utilizes the NSQIP-P to provide a comprehensive multicenter view of pediatric patients undergoing TE. Increased understanding of risk factors for complications allows for guidance in patient selection and helps in achieving favorable surgical outcomes.

Complications Following Tissue Expander-Based Reconstruction in Pediatric Burn Injuries

“…Over a fifth of patients (21.4%) in this study cohort experienced SSI, while 17.9% had wound dehiscence. The rate of SSI reported in previous studies ranges from 4 to 9% 2,10,16–21,23,24,26,31 . Previous studies from Jeschke et al and Yeong et al showed that larger TBSA and deeper burns were associated with a greater risk of complications, including SSI 6,8,9 .…”

“…The rate of SSI reported in previous studies ranges from 4 to 9%. 2,10,[16][17][18][19][20][21]23,24,26,31 Previous studies from Jeschke et al and Yeong et al showed that larger TBSA and deeper burns were associated with a greater risk of complications, including SSI. 6,8,9 Similarly, this study showed a significant association between large TBSA, a higher number of TEs, and the likelihood of wound complications, including SSI.…”

“…[16][17][18][19][22][23][24] Several risk factors for these postoperative complications have been reported in the literature, including large total body surface area (TBSA) burns, deep burns, and patients' overall health. 1,7,9,10,17,21,25,26 While the existing literature provides a fundamental understanding of postoperative complications and associated risk factors in TE-based reconstruction, a discernible gap remains concerning the comprehensive analysis of these factors and their interplay, especially within pediatric populations. 21,27 Notably, analyses identifying risk factors for specific complications such as premature expander removal are often confined to limited patient populations or specific anatomical areas, underscoring the need for a more comprehensive understanding of the risk landscape across pediatric burn cases.…”

“…The most commonly reported complication is infection, presenting a significant impediment to successful reconstructive outcomes and further extending the reconstructive process 16–19,22–24 . Several risk factors for these postoperative complications have been reported in the literature, including large total body surface area (TBSA) burns, deep burns, and patients' overall health 1,7,9,10,17,21,25,26 …”