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Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway
Thomas R Cawthorn1, Anna R Todd1, Nina Hardcastle2
1Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
Summary
Implementing a standardized perioperative care pathway for cleft palate repair significantly reduced hospital stays and opioid use while improving oral intake in infants. This approach is safe and effective for pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Clinical Pathway Development
Background:
- Cleft palate repair is a common pediatric surgical procedure.
- Standardized care pathways can optimize perioperative management and patient outcomes.
- Multimodal analgesia and specific protocols are key components of enhanced recovery after surgery.
Purpose of the Study:
- To evaluate the development and clinical impact of a standardized perioperative clinical care pathway for cleft palate repair.
- To assess the pathway's effect on length of hospital stay, opioid consumption, and postoperative oral intake.
- To determine the safety and feasibility of implementing this standardized pathway in a pediatric tertiary care setting.
Main Methods:
- Retrospective review of 40 patients (historical control) undergoing cleft palate repair before pathway implementation.
- Prospective collection of data for 40 patients treated with the standardized pathway.
- Pathway development involved literature review, expert opinion, and stakeholder input, integrating multimodal analgesia and standardized perioperative protocols.
Main Results:
- Pathway implementation led to a significant reduction in mean length of hospital stay (31 vs 57 hours, P < .001).
- Cumulative opioid consumption was markedly decreased (77 vs 727 μg/kg, P < .001) with the pathway.
- Time to initiate oral intake (9.3 vs 22 hours, P = .01) and volume of oral intake (379 vs 171 mL, P < .001) improved post-pathway.
Conclusions:
- A standardized perioperative clinical care pathway for cleft palate repair is safe and feasible.
- The pathway significantly reduces length of hospital stay and opioid consumption.
- Implementation of this pathway improves postoperative oral intake in pediatric patients.
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