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Plastic Surgeon Closure In Pediatric Spine Surgery: Comparable Outcomes Despite Greater Patient Complexity
Victoria Kong, BS, Andrew Salib, BA, Joshua Sanchez, BA, Omar Allam, MD, Jake Moscarelli, BS, Martin Kauke-Navarro, MD, Michael Alperovich, MD, James Clune, MD, Marten Basta, MD.
Yale School of Medicine, New Haven, CT, USA.
PURPOSE: Plastic surgeons are increasingly consulted for complex spine surgery closures but their impact on pediatric outcomes remains unclear. We present the largest and first multi-institutional, national-level study to evaluate complication rates, readmissions, reoperations, and length of stay (LOS) associated with plastic surgeon-assisted closure in pediatric spine surgery.
METHODS: We conducted a multicenter retrospective cohort study of patients ≤18 years undergoing spine surgery (2000-2025) using the Pediatric Health Information System. Cases with plastic surgeon-assisted closure were compared to neurosurgical/orthopedic closure. Propensity score matching (1:2) adjusted for demographic, comorbidity, and perioperative differences. Outcomes were analyzed with logistic regression using Firth’s penalized likelihood with Bonferroni correction.
RESULTS: Among 20,652 cases, 144 (0.7%) involved plastic surgeon closure. These patients were significantly more medically complex (complex chronic conditions 84.0% vs 44.5%, p<0.001). After matching, there were no significant differences in rates of medical or wound complications (Table 1), 90-day reoperation, or mortality (p=1.00 and 0.093, respectively). 90-day readmission was higher with plastics closure (OR 1.77, 95% CI 1.11-2.80), but not significant after correction (p=0.164). LOS was significantly prolonged by 18.8 days (95% CI, 12.8-24.8; p<0.001).
CONCLUSION: Plastic surgeons were disproportionately involved in more complex pediatric spine cases yet achieved complication and reoperation rates comparable to less complex cases closed by neurosurgery or orthopedics. These findings support broader involvement of plastic surgeons in complex spinal closure management.
Table 1. Adjusted Odds Ratios for Postoperative Outcomes With Plastic Surgeon Closure After Matching| Outcome | OR (95% CI) | p-value |
| Medical Complication | | |
| Pneumonia | 1.30 (0.67-2.44) | 1.00 |
| Central Line and Transfusion Infections | 2.00 (0.16-24.75) | 1.00 |
| Venous Thromboembolism | 0.39 (0.00-4.90) | 1.00 |
| Sepsis | 1.07 (0.25-3.84) | 1.00 |
| Wound Complication | | |
| Hematoma and Seroma | 3.44 (1.08-12.34) | 0.373 |
| Surgical Site Infection | 1.65 (0.44-5.89) | 1.00 |
| Dehiscence | 2.96 (0.88-10.85) | 0.785 |
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