Trends of Staged Versus Single-Stage Operations for Bilateral Cleft Lip Repair: Analysis of a National Database

Single-stage bilateral cleft lip repair may require preoperative naso-alveolar molding (NAM) to decrease cleft widths and reposition the premaxilla. Staged operations may be performed in centers or regions without easy access to NAM. This retrospective study aims to examine the national prevalence of single-stage and staged bilateral cleft lip repairs over the past 23 years.

This retrospective study used TriNetX, a national deidentified aggregate database. The study used CPT codes to identify patients younger than 12 months who underwent single-stage (CPT-40701) or staged (CPT-40702) operation for bilateral cleft lip repair between 1/1/2000 to 9/16/2023. Patients were categorized by the year of their cleft lip repair. Patient demographics were analyzed through TriNetX. Linear regression analysis was conducted using PRISM software.

Of the 1303 patients who underwent bilateral cleft lip repair, 57 patients were billed for both operations and were excluded from the analysis. In the remaining cohort, 1136 (91%) patients had a single-stage, and 110 (9%) had a staged bilateral cleft lip repair. No significant demographic differences were found between the 2 groups.The incidence of staged operations increased from 0 patients in 2000 to 14 patients in 2022. The incidence of single-stage operations increased from 6 patients in 2000 to 81 patients in 2022. Staged operations were rare in the first decade, accounting for 2% (n=5) of all bilateral cleft lip repairs between 2000 and 2011. The prevalence of staged operations showed a positive linear correlation ( R2 =0.75, P <0.0001) over the 23-year period, rising from 0% (n=0) in 2000 to 17% (n=12) in 2023.

Most bilateral cleft lip repairs have remained single-stage operations; however, staged approaches have also increased in popularity. This could indicate that NAM is less effective in patients with wide, severe bilateral cleft lip and palate, and surgeons may need to rely on a 2-stage approach for these patients.