The Impact of Diagnosis Complexity, Age, Race, and Socioeconomic Factors in Microtia Reconstruction: An Analysis of Over 1000 Surgical Cases From the Pediatric Health Information System Database

Background: Microtia, a congenital difference of the external ear, requires complex, specialized care. Access to care and the influencing factors for microtia reconstruction have not been comprehensively evaluated. This study uses the PHIS database to assess how age, race, and socioeconomic factors (Child Opportunity Index [COI]) influence access for microtia reconstruction, regardless of surgical approach, in the United States. Methods: A PHIS database query was conducted from 2016 to 2024. Patients with a diagnosis of microtia and related procedures were identified. Key variables, including age, race, gender, COI, and payor type, were statistically analyzed. Results: Only index procedures for both autologous and alloplastic-based reconstruction were evaluated, and the final sample size consisted of 1,072 procedures. The average age at surgery was 10.5 years, with most procedures performed in late childhood and the majority of patients identifying as Hispanic and publicly insured. Among microtia patients with complex chronic conditions, females were significantly older at surgery than males. Among publicly insured patients, White patients had surgery earlier than their non-White peers, a trend that was opposite in privately insured patients. Patients who underwent alloplastic-based reconstruction were, on average, younger than those who underwent autologous-based reconstruction. Conclusion: Timing of index microtia reconstruction and reconstructive approach varied across patient subgroups, highlighting potential differences in access to care and treatment patterns in this population. Future studies should determine whether these differences are associated with downstream clinical or psychosocial outcomes.