Patient risk factors for ambulatory cleft lip repair: an outcome and cost analysis

The purpose of this study was to identify variables that may preoperatively predict successful outcomes in ambulatory cleft lip repair and to quantify the potential cost savings.

A retrospective chart review of all patients who underwent cleft lip repair at a tertiary cleft care center from January of 2010 to May of 2013 was performed. Because inpatient stay is the authors' current practice, overnight desaturations, poor oral intake, and failure to stop intravenous narcotics during the first day were considered indicators of a poor candidate. Charge data were also collected.

Twenty-nine of 111 patients were deemed likely to fail ambulatory surgery. American Society of Anesthesiologists score greater than 2 (p=0.019), low birth weight (p=0.022), bilateral cleft lip-cleft palate (p=0.003), central nervous system or neurologic diagnosis (p=0.046), syndromic and/or multiple congenital abnormalities (p=0.024), prior emergency room visits (p=0.021), failure to thrive (p=0.046), and age older than 7 months (p=0.028) were associated with poor candidacy. A diagnosis of cleft lip was protective (p=0.015). Fifty-five patients had no risk factors for a poor ambulatory outcome and did not stay more than 1 day. The average savings per patient who met the authors' criteria was $4261.

The authors found that 49.5 percent of children may be safely eligible for ambulatory cleft lip repair. Patients with risk factors may be best served by a short hospital admission. This would lead to a national savings of $8,765,183 per year.