Related Experiment Video
Updated: Jun 5, 2025
Author Spotlight: Investigating Wound Healing in Mice Models of Oronasal Fistulas
Published on: September 8, 2023
Undernutrition in Cleft Palate Surgery: Effects on Postoperative Fistula Formation in a Tertiary Children's Hospital
Saleigh Adams1, Amber Mahieu2, Pien M Verreijdt2
1Division of Plastic, Reconstructive and Maxillo-Facial Surgery, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, ZA.
Insights
Perioperative undernutrition significantly increases the risk of fistula formation after cleft palate surgery. This finding highlights the importance of nutritional status in surgical outcomes for children in low-resource settings.
Area of Science:
- Pediatric surgery
- Nutritional science
- Public health in low- and middle-income countries (LMIC's)
Background:
- Fistula development is a known complication of cleft palate surgery.
- Undernutrition generally increases postoperative complications, but its specific impact on fistula formation after cleft palate repair in LMIC's is understudied.
Purpose of the Study:
- To investigate the association between perioperative undernutrition and the risk of postoperative fistula formation in South African children undergoing cleft palate surgery.
Main Methods:
- Retrospective review of 337 cleft palate patients undergoing initial repair.
- Undernutrition assessed using World Health Organization (WHO) Weight-For-Age (WFA) Z-scores.
- Longitudinal Generalized Estimation Equations (GEE) analysis to determine the influence of WFA Z-scores on fistula development.
Main Results:
- The cohort's mean WFA Z-score was -0.873.
- 21.9% of patients were underweight (Z-Score < -2) and 8.8% severely underweight (Z-Score < -3) perioperatively.
- A total symptomatic fistula rate of 19.9% was observed; lower WFA Z-scores (worsening undernutrition) significantly predicted increased odds of fistula formation (OR=1.233, P=0.018).
Conclusions:
- Worsening perioperative undernutrition is significantly associated with an increased risk of postoperative fistula formation following initial cleft palate surgery.
- Nutritional status is a critical factor influencing surgical outcomes in pediatric cleft palate repair, particularly in resource-limited settings.
Background:
Cleft palate surgery can be complicated by fistula development. It is well known that undernutrition in general leads to more postoperative complications. However, little is known about postoperative fistula development after cleft palate surgery in low- and middle-income countries (LMIC's).
Objective:
The aim of this study was to investigate the influence of peri-operative undernutrition on the risk of postoperative fistula formation in South African children operated on for cleft palate (CP).
Design And Setting:
Three hundred thirty-seven cleft palate patients undergoing initial cleft palate repair at Red Cross War Memorial Children's Hospital were retrospectively reviewed.
Interventions:
Undernutrition was measured as World Health Organisation (WHO) Weight-For-Age (WFA) Z-scores, postoperative fistula was noted when the patient received revision surgery for fistula after the initial repair.
Main Outcome Measure:
Longitudinal Generalized Estimation Equations (GEE) analysis was used to examine the influence of the undernutrition Z-Score on post-operative fistula formation.
Results:
Our cohort had a mean Z-score of -0.873 (SD=1.6043). Among patients undergoing initial cleft palate repair, 21.9% were perioperatively underweight for age (Z-Score < -2), and 8.8% were severely underweight (Z-Score < -3). The cohort had a total symptomatic fistula rate of 19.9%. Decreasing perioperative WFA Z-Score (worsening undernutrition), predicts a significant increase in the odds of postoperative fistula (odds ratio = 1.233, P = 0.018).
Conclusions:
Worsening perioperative undernutrition in initial cleft palate surgery is associated with a significant postoperative increase in fistula formation.
Related Concept Videos
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...