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Oronasal Fistula Risk After Palate Repair
Sarah Hatch Pollard1, Jonathan R Skirko1, Dallin Dance2
1Division of Pediatric Otolaryngology-Head & Neck Surgery, 7060University of Utah and Primary Children's Hospital, Salt Lake City, USA.
Insights
Two-stage palate repair increases oronasal fistula risk. Higher surgeon volume protects single-stage repair patients, while older age at repair benefits two-stage cases. Surgeon and volume are key factors.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Oronasal fistula is a complication of cleft palate repair.
- Identifying risk factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To assess risk factors for oronasal fistula after primary palate repair.
- Specifically evaluate the impact of two-stage palate repair on fistula rates.
Main Methods:
- Retrospective analysis of 584 non-submucosal cleft palate repairs performed between 2005-2013.
- Hierarchical binary logistic regression used to identify significant predictors of fistula.
- Variables included surgical approach (single-stage vs. two-stage), surgeon volume, patient demographics, and socioeconomic factors.
Main Results:
- Overall fistula rate was 10.1%. Two-stage repairs had a significantly higher fistula rate (12.6%) compared to single-stage repairs (6.7%).
- Significant predictors of fistula in the overall cohort were two-stage repair, surgeon volume, and surgeon.
- In single-stage repairs, higher surgeon volume was protective. In two-stage repairs, older age at hard palate closure was protective.
Conclusions:
- Two-stage palate repair, surgeon, and surgeon volume are significant predictors of oronasal fistula.
- Older age at hard palate repair is protective in patients undergoing two-stage repair.
- Surgical technique, surgeon experience, and patient age influence fistula development.
Objective:
To assess risk factors for oronasal fistula, including 2-stage palate repair.
Design:
Retrospective analysis.
Setting:
Tertiary children's hospital.
Patients:
Patients with non-submucosal cleft palate whose entire cleft repair was completed at the study hospital between 2005 and 2013 with postsurgical follow-up.
Interventions:
Hierarchical binary logistic regression assessed predictive value of variables for fistula. Variables tested for inclusion were 2 stage repair, Veau classification, sex, age at surgery 1, age at surgery 2, surgeon volume, surgeon, insurance status, socioeconomic status, and syndrome. Variables were added to the model in order of significance and retained if significant at a .05 level.
Main Outcome Measure:
Postoperative fistula.
Results:
Of 584 palate repairs, 505 (87%) had follow-up, with an overall fistula rate of 10.1% (n = 51). Among single-stage repairs (n = 211), the fistula rate was 6.7%; it was 12.6% in 2-stage repairs (n = 294, P = .03). In the final model utilizing both single-stage and 2-stage patient data, significant predictors of fistula were 2-stage repair (odds ratio [OR]: 2.5, P = .012), surgeon volume, and surgeon. When examining only single-stage patients, higher surgeon volume was protective against fistula. In the model examining 2-stage patients, surgeon and age at hard palate repair were significant; older age at hard palate closure was protective for fistula, with an OR of 0.82 (P = .046) for each additional 6 months in age at repair.
Conclusions:
Two-stage surgery, surgeon, and surgeon volume were significant predictors of fistula occurrence in all children, and older age at hard palate repair was protective in those with 2-stage repair.
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