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Ambulatory surgery for cleft lip repair
1University of Massachusetts Medical Center, Division of Plastic and Reconstructive Surgery, Worcester 01655, USA.
Insights
Ambulatory cleft lip repair is safe and effective, allowing infants to feed sooner and with fewer complications compared to traditional inpatient care. This approach supports early home care by parents.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Craniofacial Surgery
Background:
- Standard cleft lip repair involves preadmission testing, surgery, and inpatient postoperative care.
- Ambulatory cleft lip repair aims to facilitate safe, early home care for infants by parents.
- This study retrospectively compares outcomes of ambulatory versus inpatient cleft lip repair.
Purpose of the Study:
- To evaluate the outcomes of ambulatory cleft lip repair compared to inpatient cleft lip repair.
- To assess key parameters including time to first feeding and complication rates.
Main Methods:
- Retrospective analysis of 24 unilateral cleft lip repairs performed between 1989 and 1998.
- Two groups: Group 1 (N=11) ambulatory repair, Group 2 (N=13) inpatient repair.
- Evaluated surgical technique, ancillary procedures, local anesthetic, steroid use, feeding times, and complications.
Main Results:
- Ambulatory patients received a mixed local anesthetic and IV steroids more frequently (92% vs. 33%).
- Ambulatory group had significantly faster first postoperative feeding times (over 1 hour sooner, p < 0.05).
- No complications in the ambulatory group; two minor wound separations in the inpatient group.
Conclusions:
- Ambulatory cleft lip repair demonstrates safety and efficacy, comparable to inpatient procedures.
- Supports the continued practice of ambulatory cleft lip repair for improved patient outcomes and earlier home discharge.
- Facilitates earlier feeding and reduces complication rates, enhancing the infant's recovery process.
Abstract:
Standard of care for cleft lip repair has included preadmission testing, surgical correction, and postoperative hospital care. Driven not by managed care economics but to speed the safe home care of infants by parents, the authors have gained experience in ambulatory cleft lip repair. In this retrospective study the authors evaluated the outcome of patients who underwent ambulatory cleft lip repair compared with those patients who were hospitalized after surgery. From 1989 to 1998, 24 cleft lip repairs in 24 patients performed by the senior author were evaluated. Two groups were treated. Group 1 (N = 11) consisted of ambulatory unilateral cleft lip repairs and group 2 (N = 13) consisted of inpatient unilateral cleft lip repairs. Important surgical factors considered were technique of cleft lip repair, performance of ancillary procedures, type of local anesthetic administered, and intravenous steroid administration. Time to first postoperative feeding and complications, including bleeding, spontaneous or traumatic wound dehiscence, and infection, were considered important outcome parameters. There were no differences in surgical technique or use of antibiotics and postoperative analgesics between the two groups. None of the patients in group 1 underwent ancillary procedures. Four patients underwent soft palate repair and 3 patients underwent insertion of myringotomy tubes among group 2 patients. The use of a 1:1 mixture of 1% lidocaine and 0.5% bupivacaine with epinephrine vs. 1% lidocaine with epinephrine as a local anesthetic and intravenous steroid administration was greater in group 1 (92%) than in group 2 (33%) patients. The average time to the first postoperative feeding was more than 1 hour sooner in the ambulatory group (p < 0.05) compared with the hospitalized group (excluding the 4 patients who underwent soft palate repair). There were no complications among patients with ambulatory cleft lip repair, and there were two cases of minor wound separation in patients who received postoperative hospital care. Although many variables factor into the outcome after cleft lip repair, these data support the safety and continued practice of ambulatory cleft lip repair.
