Plastic surgeon closure in pediatric spine surgery: Comparable outcomes despite greater patient complexity.

Abstract

Pediatric spine surgery closure poses unique challenges owing to smaller body habitus, limited soft-tissue coverage, and high rates of congenital and neuromuscular deformities. Plastic surgeons are increasingly being consulted for complex closures, but outcomes in pediatric populations remain limited to small institutional series. We evaluated national patterns, outcomes, and safety of plastic surgeon-assisted closure. A retrospective multicenter cohort study used the Pediatric Health Information System database (2000-2025) to identify pediatric spine surgeries. Plastic involvement was identified via hospital-reported specialty designation codes. Postoperative complications, 90-day readmission, 90-day reoperation, and length of stay were compared between plastic and orthopedic/neurosurgical closures. Propensity score matching (1:1) balanced demographics, comorbidities, and surgical specialty. Logistic regression with Firth's penalization and Bonferroni correction provided adjusted analyses. Among the 20,903 cases, 165 (0.8%) involved plastic closure. These patients were more medically complex, with higher complex chronic condition rates (84% vs. 44%, p < 0.001) and dual neurosurgical-orthopedic involvement (6.1% vs. ≤0.8%, p < 0.001). After matching, plastic surgeon closure was not associated with increased or decreased odds of any complication, including cerebrospinal fluid leak, wound dehiscence, infection, hematoma, or seroma, as well as readmission or reoperation (all p_adj > 0.05). Plastic involvement remained independently associated with longer hospital length of stay (mean +15.9 days; 95% CI 8.6-23.2; p < 0.001). Plastic surgeons manage disproportionately complex pediatric spine cases while achieving complication and reoperation rates comparable to less complex closures, supporting strategic integration of plastic surgical expertise in complex pediatric spine reconstruction.