Otoplasty Utilization and Cost Trends in Tertiary Care Children's Hospitals.

BACKGROUND: This study examines temporal trends in otoplasty volume and inflation-adjusted cost, and characterizes variation by patient age, sex, anesthesia type, insurance, and geographic region using a national pediatric hospital database. METHODS: Retrospective cohort analysis of the Pediatric Health Information System (PHIS) database. Patients undergoing otoplasty (CPT 69300) from 2000 to 2025 were identified. Patients with congenital ear malformations other than a prominent ear (ICD-10 Q17.5) were excluded. Annual procedure volume and inflation-adjusted estimated costs were modeled with ordinary least-squares regression. Differences in cost across anesthesia type, insurance category, and census region were assessed with Kruskal-Wallis and Wilcoxon pairwise tests. RESULTS: A total of 3428 patients underwent otoplasty (51.7% male). Annual volume increased significantly (β=3.7 procedures/year, R2=0.57, P<0.001). Inflation-adjusted median cost rose by $161/year (R2=0.67, P<0.001). Median age at surgery was 8.0 years (IQR: 6-12). General anesthesia was associated with higher costs than local anesthesia ($6930 versus $5355; P<0.001). Costs were highest in the West ($7136) and lowest in the South ($4793; P<0.001). Medicaid/CHIP patients incurred higher median costs than privately insured patients ($7188 versus $6496; P=0.010). CONCLUSIONS: Otoplasty utilization and real costs have increased significantly at U.S. children's hospitals over the past 2 decades. Meaningful variation exists by anesthesia type, payer, and geography. These findings highlight opportunities to standardize care delivery and address cost disparities in pediatric otoplasty.