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Optimal Timing of Palatoplasty in Infants With Comorbidities
Christopher L Kalmar1, Vijay A Patel2, Zachary D Zapatero1
1Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, PA, USA.
Insights
Optimal timing for cleft palate repair in infants with comorbidities varies by cleft severity. Delaying surgery for more severe clefts (Veau III and IV) is linked to fewer complications, improving outcomes for these patients.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- The ideal timing for palatoplasty (cleft palate repair) is debated.
- Early repair may improve speech and hearing, but delayed repair might reduce midface growth disruption.
Purpose of the Study:
- To determine the optimal timing of palatoplasty in pediatric patients with comorbidities to minimize perioperative complications.
Main Methods:
- Retrospective cohort study.
- Utilized data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric.
- Analyzed palatoplasty outcomes in children under 2 years old with comorbidities.
Main Results:
- For Veau I/II clefts, palatoplasty after 125 days was associated with decreased adverse events (P < .001).
- For Veau III clefts, palatoplasty after 225 days showed reduced complications (P = .010).
- For Veau IV clefts, delaying repair until after 250 days correlated with fewer adverse events (P = .045).
Conclusions:
- Infants with comorbidities and more severe cleft palates (higher Veau classification) benefit from delayed palatoplasty.
- Age-dependent perioperative thresholds exist for cleft palate repair, with older age associated with better outcomes for extensive clefts.
Objective:
Ideal timing of palatoplasty continues to be debated given that early repair is thought to improve speech and hearing, whereas delayed repair is associated with less midface growth disruption. The purpose of this study is to elucidate optimal timing of palatoplasty in patients with comorbidities to mitigate perioperative complications.
Design:
Retrospective cohort study.
Setting:
Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program Pediatric.
Patients:
Palatoplasty performed for children younger than the age of 2 years with comorbidities.
Outcomes:
Medical/surgical complications, reoperations, readmissions within 30 days postoperatively.
Results:
Patients with comorbidities having Veau I or II cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 125 days of age (P < .001). Patients with comorbidities having Veau III cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 225 days of age (P = .010). Patients with comorbidities having Veau IV cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 250 days of age (P = .045).
Conclusions:
Infants with comorbidities having progressively increasing Veau classification demonstrate unique age-dependent perioperative thresholds, such that more extensive phenotypes are associated with better perioperative outcomes with older age at time of cleft palate repair.
