Temporal Shifts and Geographical Characteristics of Surgical Specialty Involvement in Surgical Microtia Care in the Pediatric Health Information System Database

Background Microtiais a congenital external ear anomaly requiring reconstruction, typically performed by plastic surgery or otolaryngology (ENT). This study examined temporal and geographic trends in specialty involvement in microtia reconstruction using the Pediatric Health Information System (PHIS) database. Methods PHIS was queried from 2016 to 2024 for patients ≤21 years with microtia undergoing ear reconstruction. Patient characteristics, surgical specialty, and geographic region were analyzed. Adjusted temporal trends in plastic surgery versus ENT involvement were assessed using multivariable logistic regression controlling for seasonality, geography, medical complexity, acuity, and age. Results Among 1176 cases, median age was 9 years; 58.5% were male, 56.6% Hispanic/Latino, and 73.0% publicly insured. Overall, 49.1% ( n = 577) of reconstructions were performed by ENT, 41.3% ( n = 486) by plastic surgery, and 9.6% ( n = 113) by other specialties. Adjusted probability of plastic surgery versus ENT involvement remained stable from 48.6% in January 2016 to 45.7% in December 2024 ( p = .755). Medical complexity was associated with greater odds of plastic surgery involvement (odds ratio (OR): 4.94, 95% confidence interval (CI): 1.54-15.85). Compared with the West, plastic surgery involvement was greater in the Midwest and South, particularly the East North Central (OR: 12.9, 95% CI: 2.1-78.9) and South Atlantic (OR: 11.9, 95% CI: 2.3-60.8) divisions. Conclusion Specialty involvement in pediatric microtia reconstruction remained stable over time but varied geographically and by medical complexity. Findings of this study suggest regional practice patterns and workforce may influence specialty involvement.