Porous Polyethylene Versus Autologous Costochondral Reconstruction for Microtia: Incidence and Analysis of Secondary Procedures

Abstract

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.

Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP‐P Database

“…It is well known that patients undergoing autologous cartilagebased reconstruction need a greater number of operations to achieve complete reconstruction. 13,20 The autologous rib reconstruction technique popularized by Brent requires 4 separate procedures for complete reconstruction. 25 Analysis of this technique has found many stages to be difficult and time-consuming with several authors also reporting secondary complications in chest donor sites.…”

“…The finding of longer operative times with alloplastic implants is not unexpected given the single‐stage nature of this technique, however these findings are limited when analyzing procedures based on CPT codes. It is well known that patients undergoing autologous cartilage‐based reconstruction need a greater number of operations to achieve complete reconstruction 13,20 . The autologous rib reconstruction technique popularized by Brent requires 4 separate procedures for complete reconstruction 25 .…”

“…13,18,19 Autologous cartilage-based reconstruction is associated with significantly more operations, better color match outcomes, and lower overall complication rates. 13,19,20 However, documented complication rates and comparison between reconstruction methods have been limited to small, low-impact studies. To our knowledge, no study has investigated comparative outcomes between different microtia reconstruction techniques on a national scale.…”

“…Current literature consistently associates alloplastic implant‐based reconstruction with increased rates of complications, infections, and implant exposure, but significantly better cosmetic outcomes in ear definition, size, and shape 13,18,19 . Autologous cartilage‐based reconstruction is associated with significantly more operations, better color match outcomes, and lower overall complication rates 13,19,20 . However, documented complication rates and comparison between reconstruction methods have been limited to small, low‐impact studies.…”