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

The aim of a cleft lip repair is to achieve a functional and aesthetically acceptable upper lip and nose appearance. However, the methods of assessing severity and outcome are still very subjective. Fortunately, it is recognised that human judgement can act as a very reliable tool in assessing facial attractiveness. Therefore, using a simple subjective assessment method, a multi-centre comparison study was performed. Following the Clinical Standards Advisory Group review (1998) and subsequent reconfiguration of the cleft services in the UK a tri-centre comparative audit, involving three out of the nine designated UK cleft centres, was set up. Photographs of 37 patients (consecutive where possible), with complete unilateral cleft lip defects from six regional cleft units (seven surgeons), taken preoperatively and then taken 5 years postoperatively were examined by 10 medical and 10 laypersons to rate the severity and perceived difficulty of repair preoperatively and aesthetic outcome postoperatively. This was repeated after 2 weeks. A five-point scale was used for the assessment. Weighted kappa scores were used to assess agreements within and between rater reliability. Results showed high levels of intra- and inter-rater reproducibility in both groups of raters. This technique was used as a ranking tool to assess the aesthetic outcomes of surgical repair and thereby rank surgeons within our supra-regional audit. This technique can be employed to aid education, stimulate research and also coordinate national inter-centre comparisons following cleft lip repairs.