Predictors of Adverse Events Following Cleft Palate Repair

Cleft palate repair has rare, but potentially life-threatening risks. Understanding the risk factors for adverse events following cleft palate repair can guide surgeons in risk stratification and parental counseling.

Patients under 2 years of age in National Surgical Quality Improvement Project Pediatric Database (NSQIP-P) from 2012 to 2016 who underwent primary cleft palate repair were identified. Risk factors for adverse events after cleft palate repair were identified.

Outcomes for 4989 patients were reviewed. Mean age was 1.0 ± 0.3 years and 53.5% were males. Adverse events occurred in 6.4% (320) of patients. The wound dehiscence rate was 3.1%, and the reoperation rate was 0.9%.On multivariate analysis, perioperative blood transfusion (adjusted odds ratio [aOR] 30.2), bronchopulmonary dysplasia/chronic lung disease (aOR 2.2), and prolonged length of stay (LOS) (aOR 1.1) were significantly associated with an adverse event.When subdivided by type of adverse event, reoperation was associated with perioperative blood transfusion (aOR 286.5), cerebral palsy (aOR 11.3), and prolonged LOS (aOR 1.1). Thirty-day readmission was associated with American Society of Anesthesiologists Physical Status Classification class III (aOR 2.0) and IV (aOR 4.8), bronchopulmonary dysplasia/chronic lung disease (aOR 2.5), cerebral palsy (aOR 5.7), and prolonged LOS (aOR 1.1). Finally, wound dehiscence was significantly associated with perioperative blood transfusion only (aOR 8.2).

Although adverse events following cleft palate surgery are rare, systemic disease remains the greatest predictor for readmission and reoperation. Neurologic and pulmonary diseases are the greatest systemic risk factors. Intraoperative adverse events requiring blood transfusion are the greatest surgical risk factor for post-surgical complications.