A Nationwide Analysis of the Impact of Cardiopulmonary Anomalies on Cleft Palate Surgical Outcomes
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Published on: September 19, 2015
Eloise W Stanton1,2, Artur Manasyan1,2, Idean Roohani1,2
1Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Patients with cleft palate (CP) and coexisting congenital heart disease (CHD) or congenital pulmonary disease (CPD) face higher risks of complications and longer hospital stays after surgery. Comprehensive pre-operative evaluation is crucial for optimizing care.
Area of Science:
- Pediatric Surgery
- Cardiology
- Pulmonology
- Medical Informatics
Background:
- Cleft palate (CP) repair is a common pediatric surgical procedure.
- Coexisting congenital cardiopulmonary anomalies can complicate perioperative management.
- Improved awareness and care protocols are needed for these high-risk patients.
Purpose of the Study:
- To investigate the impact of coexisting congenital heart disease (CHD) and congenital pulmonary disease (CPD) on perioperative outcomes in patients undergoing cleft palate (CP) repair.
- To enhance understanding of risks associated with CP repair in patients with cardiopulmonary anomalies.
Main Methods:
- Retrospective, multi-center cohort study.
- Analysis of data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File (2012-2020).
- Statistical analysis including chi-squared tests, Student's t-tests, and logistic regression to assess associations between CP, CHD/CPD, and outcomes.
Main Results:
- Over 17,000 patients with CP were identified; 16.0% had CHD and 13.2% had CPD.
- Patients with CHD and CPD experienced significantly longer lengths of stay (LOS).
- Increased rates of perioperative complications, except wound dehiscence, were observed in patients with coexisting CHD/CPD.
Conclusions:
- Congenital cardiopulmonary disease is significantly associated with adverse outcomes following cleft palate repair.
- Heightened clinical suspicion for coexisting anomalies is warranted in CP patients.
- Multidisciplinary evaluation and cardiopulmonary optimization are essential before surgical intervention for CP.
Abstract:
ObjectiveTo increase awareness and improve perioperative care of patients with cleft palate (CP) and coexisting cardiopulmonary anomalies.DesignRetrospective cohort.SettingMulti-center.Patients/ParticipantsPatients who underwent surgical repair of CP between 2012-2020 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Chi-squared analysis and Student's t-test were implemented to make associations between congenital heart disease (CHD) and congenital pulmonary disease (CPD) and postoperative complications. Multiple logistic regression was performed to identify associations between CP and CHD/CPD while controlling for age, gender, and ASA class. C2 values were used to assess the logistic regressions, with a significance level of 0.05 indicating statistical significance.Main Outcomes MeasuresLength of stay (LOS), perioperative complications (readmission, reoperation, reintubation, wound dehiscence, cerebrovascular accidents, and mortality).Results9 96 181 patients were identified in the database, 17 786 of whom were determined to have CP, of whom 16.0% had congenital heart defects (CHD) and 13.2% had congenital pulmonary defects (CPD). Patients with CHD and CPD were at a significantly greater risk of increased LOS and all but one operative complication rate (wound dehiscence) relative to patients with CP without a history of CHD and CPD.ConclusionThis study suggests that congenital cardiopulmonary disease is associated with increased adverse outcomes in the setting of CP repair. Thus, heightened clinical suspicion for coexisting congenital anomalies in the presence of CP should prompt referring providers to perform a comprehensive and multidisciplinary evaluation to ensure cardiopulmonary optimization prior to surgical intervention.
