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Evaluating the Need for Routine Admission following Primary Cleft Palate Repair: An Analysis of 100 Consecutive Cases
Benjamin C Wood1, Michael J Boyajian, David Zurakowski
1Washington, D.C.; and Boston, Mass. From the Division of Plastic Surgery, Children's National Medical Center; and Boston Children's Hospital, Harvard Medical School.
Insights
This study found that female gender, syndromic diagnosis, and longer operative times are linked to extended hospital stays after cleft palate repair. These factors suggest routine short-stay observation may not be safe for all patients.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Routine hospitalization is standard after cleft palate repair, but insurance companies are pushing for shorter stays.
- Identifying factors influencing length of stay is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To identify demographic and perioperative factors associated with prolonged hospitalization following primary cleft palate repair.
Main Methods:
- Retrospective chart review of 100 patients undergoing primary cleft palate repair (May 2009 - Feb 2013).
- Statistical analysis including t-tests and linear regression models to correlate patient data with length of stay.
Main Results:
- Median length of stay was 39 hours, with all patients exceeding 23 hours.
- Key predictors for increased length of stay included female gender, syndromic diagnosis, longer operative/anesthetic times, delayed oral intake, and lower narcotic dosage.
Conclusions:
- Factors such as female gender, syndromic diagnosis, and longer surgical times necessitate longer hospital stays.
- Findings challenge the safety of routine ambulatory or short-stay observation for primary cleft palate repair.
Background:
Routine admission following primary cleft palate repair is the standard of care at most institutions. Insurance companies have demonstrated increasing resistance to hospitalization longer than a "short stay"(23 hour) observation period following palatoplasty. The purpose of this study was to identify factors related to length of stay following palate repair.
Methods:
Retrospective chart review was conducted for 100 consecutive patients undergoing primary cleft palate repair from May 2009 to February 2013. Demographic and perioperative data were collected and two-sample Student t-test, univariate and multivariable linear regression models were performed to assess for correlation with longer length of stay.
Results:
Mean age at the time of surgery was 12.6 months. Median length of stay was 39 hours; all 100 patients had >23 hours length of stay. Seventy-three percent of patients required intravenous fluids greater than 23 hours after admission. Postoperative intravenous narcotics were required in 92 percent of patients after transfer to the post-surgical floor, and the last dose was given on average 19.8 hours after completion of surgery. There were 13 patients who required postoperative supplemental oxygen for greater than 23 hours following admission. Multivariable predictors of increased length of stay included female gender, syndromic diagnosis, longer operative and anesthetic durations, longer time to postoperative oral intake, and lower dose of postoperative intravenous narcotic.
Conclusions:
Factors identified in association with increased length of stay may guide opportunities for reducing postoperative hospitalization; however, these findings would oppose the safety of routine ambulatory surgery or short-stay observation following primary cleft palate repair.
Clinical Question/Level Of Evidence:
Risk, III.
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