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Patient Safety and Suitability for Primary Cleft Lip Repair as Day Case Surgery - A Systematic Review and
Serena V Martin1, Benedict Reed1, Nefer Fallico1
1Spires Cleft Centre, Salisbury District hospital and John Radcliffe Hospital, UK.
Insights
Day case cleft lip surgery shows no increased complication risk compared to inpatient care. This approach significantly reduces 30-day hospital readmissions for pediatric patients.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Health Services Research
Background:
- Cleft lip repair is a common pediatric surgical procedure.
- Optimizing surgical pathways, such as day case surgery, is crucial for efficient healthcare delivery.
- Assessing the safety and efficacy of day case surgery is essential for patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the impact of day case cleft lip surgery on complication rates and 30-day readmission.
- To compare outcomes of day case versus inpatient cleft lip repair in pediatric patients.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Meta-analysis conducted using RevMan 5.
- Inclusion of randomized controlled trials, observational studies, and case series involving pediatric patients undergoing primary cleft lip repair.
Main Results:
- Analysis of 10 studies with 13,804 patients; 28% underwent same-day discharge.
- No significant difference in complication rates between day case and inpatient cohorts.
- A significant reduction in 30-day readmission rates was observed in the day case group.
Conclusions:
- Day case cleft lip surgery is associated with comparable complication rates to inpatient admission.
- Day case surgery demonstrates a reduction in 30-day readmission rates.
- Observed reductions in readmissions may be influenced by pre-operative patient selection criteria.
Objective:
To perform a systematic review and meta-analysis to determine if day case cleft lip surgery has an impact on complications and 30-day readmission rate.
Design:
A systematic review was conducted using PRISMA guidelines. Databases included; PubMed, Science Direct, Ovid and Cochrane. Search terms; "Day Case", "Day Care", "outpatient", "Ambulatory" AND "Cleft", "Cleft Lip". Meta-analysis was performed using RevMan 5.
Setting:
Eligible study types included; randomised controlled trials, observational studies (prospective and retrospective) and case series.
Patients/Participants:
Paediatric patients undergoing primary cleft lip repair.
Interventions:
Day case surgery versus inpatient admission post-operative.
Main Outcome Measure(S):
Primary outcome measure: Primary cleft lip repair performed as a day case in paediatric patients. Secondary outcome measures: 1. Complication rates and 30-day re-admission to hospital rate. 2. Patient suitability for day case surgery.
Results:
Ten papers with 13 804 patients undergoing primary cleft lip repair were included, 28% were discharged on the day of surgery (Range 17%-81%). There was no significant difference in complication rate between the inpatient and day case cohorts. There was a significant reduction in 30-day readmission rates in the day case cohort.
Conclusions:
This meta-analysis indicates there is no difference in complication rates for patients discharged on the day of surgery compared to those admitted overnight. Complications encountered were infrequent, non-life threatening and often occurred more than 24 h following discharge. There was an observed reduction in 30-day readmission rates for day-case patients. This is likely to represent a variation in baseline characteristics which deemed them suitable for day case surgery pre-operatively.
