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National Estimates of and Risk Factors for Inpatient Revision Surgeries for Orofacial Clefts
Insights
Revision surgeries for cleft lip and palate are common, particularly in syndromic patients and those with private insurance. Addressing disparities in cleft care is crucial.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Health Services Research
Background:
- Cleft lip and palate (CLP) are common congenital anomalies requiring surgical intervention.
- Understanding the patterns and costs of primary versus revision surgeries is essential for optimizing patient outcomes and healthcare resource allocation.
Purpose of the Study:
- To estimate the national volume and cost of primary and revision cleft lip and palate surgeries in the U.S.
- To identify patient and hospital factors associated with increased revision surgery rates.
Main Methods:
- Retrospective cross-sectional study utilizing data from the 2003, 2006, and 2009 Kids' Inpatient Database.
- Analysis included inpatient cleft lip and/or palate surgeries performed on children.
Main Results:
- In 2009, there were 2,824 cleft lip and 5,431 cleft palate hospitalizations. Revision surgeries constituted 24.2% of cleft lip and 36.8% of cleft palate procedures.
- Children with cleft lip and palate (CLP), syndromic diagnoses, or private insurance showed higher odds of undergoing revision surgery.
- Mean hospitalization costs in 2009 ranged from $7,564 to $8,393, with no significant change from 2003 to 2009.
Conclusions:
- Targeted interventions to improve primary surgery outcomes in high-risk populations (e.g., syndromic patients) are recommended.
- The link between insurance status and revision rates underscores the need to address economic disparities in cleft care delivery.
Objective:
To provide national estimates of the number and cost of primary and revision cleft lip and palate surgeries in the U.S. and to determine patient and hospital characteristics associated with disproportionate use of revision surgery.
Design:
Retrospective cross-sectional study using data obtained from the 2003, 2006, and 2009 Kids' Inpatient Database.
Setting:
Inpatient.
Patients:
Children with CL, CP, or CLP undergoing inpatient cleft lip and/or palate surgery.
Interventions:
Inpatient cleft lip and/or palate surgery.
Main Outcome Measures:
Orofacial cleft surgery estimates, estimates of primary versus revision surgeries, and estimated inflation-adjusted hospitalization costs.
Results:
In 2009, there were a total of 2824 and 5431 hospitalizations for cleft lip and palate surgeries, respectively. Revision surgery accounted for 24.2% of cleft lip surgeries and 36.8% of cleft palate surgeries. Children with CLP (OR 1.87, 95% CI: 1.48-2.38), a syndromic diagnosis (OR 1.47, 95% CI: 1.16-1.87), or private insurance (OR 1.71, 95% CI: 1.41-2.09) were more likely to undergo cleft lip revision surgery. Similar risk factors were found for children undergoing cleft palate revision. Mean cost per hospitalization ranged from $7564 to $8393 in 2009, depending on surgery type, and did not change significantly (in 2009 U.S. $) between 2003 and 2009.
Conclusions:
Interventions to reduce revision surgery by improving results of primary surgery should be targeted in the population of identified high-risk (e.g., syndromic) patients. In addition, the association of health insurance status with revision surgery highlights the need to understand and address the impact of economic disparities on cleft care delivery.
