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Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications.
Plast Reconstr Surg 2018; 141(5):697e-706ePR

Abstract

BACKGROUND

Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015. Patient clinical factors and 30-day complications were compared for outpatient versus inpatient primary cleft lip and palate surgery. Univariate and multivariate analyses were performed.

RESULTS

Three thousand one hundred forty-two patients were included in the primary cleft lip surgery group and 4191 in the primary cleft palate surgery group. Patients in the cleft lip surgery group with structural pulmonary abnormalities had a significantly longer hospital length of stay (β, 4.94; p = 0.001). Patients undergoing outpatient surgery had a significantly higher risk of superficial (OR, 1.99; p = 0.01) and deep wound dehiscence (OR, 2.22; p = 0.01), and were at a significantly lower risk of reoperation (OR, 0.36; p = 0.04) and readmission (OR, 0.52; p = 0.02).

CONCLUSIONS

Outpatient primary cleft lip surgery is safe and has a complication profile similar to that of inpatient surgery. Outpatient primary cleft palate surgery is common practice in many U.S. hospitals and has a significantly higher rate of wound complications, and lower rates of reoperation and readmission. In properly selected patients, outpatient palatoplasty can be performed safely.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Authors+Show Affiliations

New York, N.Y.; and Baltimore, Md. From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center; and the Department of Surgery, University of Maryland Medical System.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29697617

Citation

Kantar, Rami S., et al. "Outpatient Versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications." Plastic and Reconstructive Surgery, vol. 141, no. 5, 2018, pp. 697e-706e.
Kantar RS, Cammarata MJ, Rifkin WJ, et al. Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications. Plast Reconstr Surg. 2018;141(5):697e-706e.
Kantar, R. S., Cammarata, M. J., Rifkin, W. J., Plana, N. M., Diaz-Siso, J. R., & Flores, R. L. (2018). Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications. Plastic and Reconstructive Surgery, 141(5), pp. 697e-706e. doi:10.1097/PRS.0000000000004293.
Kantar RS, et al. Outpatient Versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications. Plast Reconstr Surg. 2018;141(5):697e-706e. PubMed PMID: 29697617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications. AU - Kantar,Rami S, AU - Cammarata,Michael J, AU - Rifkin,William J, AU - Plana,Natalie M, AU - Diaz-Siso,J Rodrigo, AU - Flores,Roberto L, PY - 2018/4/27/entrez PY - 2018/4/27/pubmed PY - 2018/10/12/medline SP - 697e EP - 706e JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 141 IS - 5 N2 - BACKGROUND: Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015. Patient clinical factors and 30-day complications were compared for outpatient versus inpatient primary cleft lip and palate surgery. Univariate and multivariate analyses were performed. RESULTS: Three thousand one hundred forty-two patients were included in the primary cleft lip surgery group and 4191 in the primary cleft palate surgery group. Patients in the cleft lip surgery group with structural pulmonary abnormalities had a significantly longer hospital length of stay (β, 4.94; p = 0.001). Patients undergoing outpatient surgery had a significantly higher risk of superficial (OR, 1.99; p = 0.01) and deep wound dehiscence (OR, 2.22; p = 0.01), and were at a significantly lower risk of reoperation (OR, 0.36; p = 0.04) and readmission (OR, 0.52; p = 0.02). CONCLUSIONS: Outpatient primary cleft lip surgery is safe and has a complication profile similar to that of inpatient surgery. Outpatient primary cleft palate surgery is common practice in many U.S. hospitals and has a significantly higher rate of wound complications, and lower rates of reoperation and readmission. In properly selected patients, outpatient palatoplasty can be performed safely. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/29697617/Outpatient_versus_Inpatient_Primary_Cleft_Lip_and_Palate_Surgery:_Analysis_of_Early_Complications_ L2 - http://Insights.ovid.com/pubmed?pmid=29697617 DB - PRIME DP - Unbound Medicine ER -