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Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database
Diana S Jodeh1, Anh Thy H Nguyen1, S Alex Rottgers1
1From the Division of Plastic and Reconstructive Surgery and the Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital.
Insights
Patients with cleft lip and palate have higher rates of oronasal fistula and secondary speech surgery after primary palatoplasty. Isolated cleft palate patients experience fewer complications, indicating a need for tailored surgical approaches.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Plastic surgery
Background:
- Oronasal fistula and secondary speech surgery rates after cleft palate repair were previously limited to single-center studies.
- Large healthcare databases can overcome limitations of single-center case series for reporting clinical outcomes.
- This study examined cleft type and demographic impacts on outcomes following primary palatoplasty.
Purpose of the Study:
- To determine the prevalence of oronasal fistula and secondary speech surgery after primary palatoplasty.
- To investigate the association between cleft type and the development of oronasal fistula.
- To assess the relationship between cleft type and the need for secondary speech surgery.
Main Methods:
- Utilized the Pediatric Health Information System database for patients aged 6-18 months undergoing primary palatoplasty (2004-2009).
- Identified subsequent oronasal fistula repair and/or secondary speech surgery (2004-2015) using procedure codes.
- Employed logistic regression to analyze associations between cleft type, oronasal fistula, and secondary speech surgery.
Main Results:
- 7,325 patients were analyzed; 6.4% required oronasal fistula repair and 18.5% underwent secondary speech surgery.
- Patients with cleft lip and palate showed significantly increased odds of oronasal fistula (OR 5.60) and secondary speech surgery (OR 2.32) compared to other cleft types.
- These associations remained significant after adjusting for age, sex, and race.
Conclusions:
- A large multi-institution database confirmed higher prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency post-palatoplasty in the US.
- Patients with isolated cleft palate had fewer oronasal fistulas and required less secondary speech surgery than those with cleft lip and palate.
- Cleft type is a significant predictor of clinical outcomes following primary palatoplasty.
Background:
Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes.
Methods:
Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery.
Results:
Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63).
Conclusions:
Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate.
Clinical Question/Level Of Evidence:
Risk, III.
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