A simple assessment method for auditing multi-centre unilateral cleft lip repairs.

Area of Science:

• Plastic Surgery
• Otolaryngology
• Aesthetic Medicine

Background:

• Cleft lip repair aims for functional and aesthetic results, but outcome assessment remains subjective.
• Existing methods lack objective measures, hindering reliable comparisons.
• Human judgment is recognized as a reliable tool for assessing facial aesthetics.

Purpose of the Study:

• To develop and validate a subjective assessment method for cleft lip repair outcomes.
• To compare surgical outcomes across multiple UK cleft centers.
• To establish a reliable tool for ranking surgeon performance and aiding education.

Main Methods:

• A tri-center comparative audit involving 37 patients with complete unilateral cleft lip defects.
• Preoperative and 5-year postoperative photographs were rated by 10 medical and 10 laypersons using a 5-point scale.
• Intra- and inter-rater reliability was assessed using weighted kappa scores.

Main Results:

• High levels of intra- and inter-rater reproducibility were observed in both medical and layperson groups.
• The subjective assessment method proved effective as a ranking tool for aesthetic outcomes.
• The technique demonstrated reliability for comparing surgeons and centers.

Conclusions:

• Subjective assessment by human raters provides a reliable method for evaluating cleft lip repair outcomes.
• This technique can be used to rank surgeons and centers, promoting quality improvement.
• The method supports educational initiatives and national inter-center comparisons in cleft care.