Five-Fold Variation Among Surgeons and Hospitals in the Use of Secondary Palate Surgery

Area of Science:

• Craniofacial surgery
• Pediatric surgery
• Health services research

Background:

• Secondary palate surgery is a common follow-up procedure after primary cleft palate repair.
• Factors influencing the need for secondary palate surgery are not fully understood.
• Significant variation in surgical practice exists across healthcare providers.

Purpose of the Study:

• To identify child, surgeon, and hospital-specific factors associated with secondary palate surgery after primary cleft palate repair.
• To analyze the impact of cleft type and age at primary repair on the need for subsequent surgeries.
• To quantify the variation in secondary surgery rates among different surgeons and hospitals.

Main Methods:

• Retrospective cohort study of children undergoing primary cleft palate repair between 1998 and 2015.
• Analysis of data from 49 pediatric hospitals.
• Multivariable analysis to identify predictors of secondary palate surgery.

Main Results:

• 27.5% of children underwent secondary palate surgery within 5 years of primary repair.
• Unilateral cleft lip and palate increased the hazard of secondary surgery by 1.69 times.
• Primary repair before 9 months increased the hazard of secondary surgery by 3.99 times compared to repair at 16-24 months.
• Substantial variation in secondary surgery rates persisted among surgeons and hospitals after adjusting for known factors.

Conclusions:

• Significant disparities exist in secondary palate surgery utilization among surgeons and hospitals.
• Further investigation is required to understand the drivers of this variation.
• Interventions may be needed to standardize care and potentially reduce the need for secondary surgeries.