Perioperative management in primary palatoplasty-an international survey

Orofacial clefts are common congenital defects. Primary palatoplasty aims to address the functional problems associated with the underlying deformity and is necessary for normal speech acquisition. International consensus on the perioperative management of primary cleft palate surgery is limited. A 34-question online survey was disseminated via email between June and September 2022, to identify differences and similarities in the perioperative management of children undergoing primary palatoplasty. Overall, 297 cleft surgeons were invited to take part, of whom 72 (24.2%) responded to the survey. The mean ± standard deviation annual number of primary palatoplasties per surgeon was 43.3 ± 43.3. Mean age at the time of hard and soft palate repair was 10.8 ± 5.7 months and 10.9 ± 4.9 months, respectively. There was considerable variation in surgical antibiotic prophylaxis (duration, antibiotic agent), postoperative feeding regimen, postoperative protective/restrictive measures, and duration of inpatient stay. Significant regional differences were observed in the timing of the surgery (patient age) (P < 0.05), duration of surgical antibiotic prophylaxis (P = 0.024), postoperative feeding measures during the inpatient stay (P < 0.05), and length of in-hospital stay (P < 0.001). Perioperative management practices in primary palatoplasty vary widely between countries and institutions, including the use of surgical antibiotic prophylaxis. Nonetheless, this study indicates a consistent movement away from prolonged postoperative antibiotic courses towards short-term or even single-shot administration.