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Does the type of cleft palate contribute to the need for secondary surgery? A national perspective
James A Owusu1, Meixia Liu, James D Sidman
1Department of Otolaryngology-Head and Neck Surgery , University of Minnesota, Minneapolis, Minnesota, U.S.A.
Insights
Children with cleft lip and palate require more secondary surgeries than those with cleft palate alone. This finding highlights the importance of diagnosis type in planning follow-up care for cleft palate repair.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Plastic surgery
Background:
- Cleft palate repair is a common pediatric surgical procedure.
- Secondary surgeries, such as oronasal fistula repair and speech surgery, are sometimes necessary after primary cleft palate repair.
- The type of cleft palate diagnosis may influence the need for these secondary procedures.
Purpose of the Study:
- To investigate the association between the type of cleft palate diagnosis and the requirement for secondary surgical interventions following primary repair.
- To compare the rates of secondary cleft palate procedures between children diagnosed with cleft lip and palate versus cleft palate only.
Main Methods:
- Retrospective analysis of the 2009 Kids' Inpatient Database (KID), a national pediatric database.
- Identification of two cohorts: children undergoing primary cleft palate repair and those undergoing secondary (revision) cleft palate repair.
- Calculation of revision ratios for different cleft palate diagnoses to determine those with higher revision rates.
Main Results:
- In 2009, 1942 primary cleft palate repairs and 724 secondary cleft palate procedures were recorded in the KID.
- Children with a cleft lip and palate diagnosis exhibited a significantly higher revision rate ratio (1.92) compared to those with cleft palate only (0.54) (P <0.05).
- The average age for primary repair was 13.36 months, while for secondary procedures it was 59 months.
Conclusions:
- The initial diagnosis of cleft lip and palate is associated with a higher likelihood of requiring secondary cleft palate procedures compared to cleft palate only.
- This suggests that cleft lip and palate is a more complex condition necessitating more extensive surgical management.
- Understanding these differences can aid in predicting patient needs and optimizing treatment pathways.
Objectives/Hypothesis:
To determine whether the type of cleft palate is associated with a need for secondary surgery (oronasal fistula repair, speech surgery) after primary cleft palate repair.
Study Design:
Retrospective analysis of a national pediatric database (2009 Kids' Inpatient Database).
Methods:
We identified two distinct cohorts of children who underwent primary and secondary (revision) cleft palate repairs, respectively, from a national, pediatric database (2009 Kids' Inpatient Database). Revision ratios for each cleft palate diagnosis were calculated to identify diagnoses with higher rates of revision. Revision ratio was calculated by dividing the relative frequency of each diagnosis in the secondary repair cohort by the corresponding relative frequency in the primary repair cohort.
Results:
In 2009, there were 1942 cases of primary cleft palate repair in the 44 states participating in the KID's inpatient database. Fifty-two percent (n=1018) were male. The average age at the time of surgery was 13.36 months. In the same year secondary cleft palate procedures were performed on 724 different patients, 54% (n=388) were males. The average age for secondary procedures was 59 months. Cleft lip and palate diagnoses had higher revision rate ratios (1.92) compared to cleft palate only (0.54) P <0.05.
Conclusion:
Children with an initial diagnosis of cleft lip and palate, which is more severe than cleft palate only, have comparatively higher rates of secondary cleft palate procedures than children with cleft palate only.
Level Of Evidence:
N/A.
