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Timing of Cleft Palate Repair in Patients With and Without Robin Sequence
Gary B Skolnick1, Matthew R Keller2, Ethan J Baughman1
1Division of Plastic and Reconstructive Surgery.
Insights
Optimal cleft palate repair timing is crucial for reducing secondary procedures. Repairing at or before 10 months in children with Robin sequence or non-Robin cleft palate is linked to increased risks for further surgeries.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Health Outcomes Research
Background:
- Cleft palate repair timing is a critical factor in surgical outcomes.
- Nonsyndromic cleft palate patients, with and without Robin Sequence, present unique challenges.
- Understanding the impact of age at repair is essential for optimizing treatment protocols.
Purpose of the Study:
- To evaluate the association between age at initial palatoplasty and the need for secondary procedures in nonsyndromic cleft palate patients.
- To compare outcomes for patients with and without Robin Sequence based on the timing of surgical intervention.
- To identify optimal age windows for cleft palate repair to minimize revision rates.
Main Methods:
- A retrospective cohort study utilizing the IBM MarketScan Commercial Database.
- Identification of children under 4 years undergoing palatoplasty using ICD-9-CM and CPT codes.
- Stratification into Robin Sequence and non-Robin cleft palate groups, with further division based on age at initial repair (≤10 months, >10-14 months, >14 months).
- Cox proportional-hazards models were employed to assess time to secondary cleft palate repair.
Main Results:
- The study included 261 patients with Robin Sequence and 3046 with non-Robin cleft palate.
- Later repair (>10 months) in Robin Sequence patients was associated with a significantly decreased risk of secondary procedures (HR 0.19).
- For non-Robin cleft palate, repair at >10-14 months (aHR 0.40) and >14 months (aHR 0.71) showed reduced revision risk compared to early repair.
- Pre-existing conditions like failure to thrive or anemia increased secondary procedure risk in non-Robin patients.
Conclusions:
- Cleft palate repair at or before 10 months of age is associated with a higher risk of secondary procedures in both Robin Sequence and non-Robin cleft palate patients.
- Delayed surgical intervention beyond 10 months may lead to better long-term outcomes by reducing the need for revisions.
- These findings underscore the importance of individualized timing for palatoplasty to optimize patient outcomes.
Background:
This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims.
Methods:
Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10-14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models.
Results:
A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09-0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10-14 months (adjusted HR 0.40, 95%CI 0.31-0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57-0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty.
Conclusions:
In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.
