Differences in the surgical and financial burden of four protocols for unilateral cleft lip and palate

The treatment of unilateral cleft lip and palate (UCLP) involves up to four primary surgeries to restore oral function. This study was performed to evaluate the surgical burden and direct healthcare costs of four UCLP surgical protocols at Erasmus University Medical Centre, Rotterdam, to guide optimal protocol selection. This retrospective cohort study included UCLP patients treated during 1990-2024. The patients were categorized into groups based on the hard palate closure timing: Oslo protocol (OP), one-stage palatoplasty protocol (OSPP), early delayed hard palate closure protocol (E-DHPCP), and late delayed hard palate closure protocol (L-DHPCP). Primary surgeries were analysed for operative duration (OD) and length of hospital stay (LOS), and their associated costs were estimated. Overall, 331 patients were included. Mean cumulative OD was significantly shorter for L-DHPCP and OSPP when compared to E-DHPCP and OP, while mean cumulative LOS was significantly longer for E-DHPCP compared to the other protocols. Mean cumulative OD was 408, 465, 425, and 507 min, and mean cumulative LOS was 3.95, 4.84, 4.07, and 4.11 nights for L-DHPCP, E-DHPCP, OSPP, and OP, respectively. Mean total costs were estimated at €17,858, €20,791, €18,545, and €21,158, respectively. L-DHPCP and OSPP demonstrated the lowest surgical burden and direct healthcare costs, although differences were minor. Therefore, the choice between these four surgical protocols should continue to be based on clinical outcomes, rather than differences in burden and costs.