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Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip.

Abstract

Importance

Scar outcomes following cleft lip repair are an important component of pediatric patient and family satisfaction and indicate the need for future surgical interventions.

Objective

To assess the association of pediatric patient demographic factors and scar anatomic features with scar outcomes following cleft lip surgical repair.

Design, Setting, and Participants

A case-control study was conducted involving 58 pediatric patients who underwent surgical repair of a cleft lip from October 31, 2008, to August 4, 2016, at a tertiary care pediatric specialty hospital. Data on patient demographic factors, cleft type, and the surgical technique used were collected and analyzed from June 11, 2009, to November 21, 2017. Scar outcomes were subjectively rated by 3 physicians at 6-month and 12-month postoperative intervals.

Main Outcomes and Measures

Overall scar outcomes at 6-month and 12-month postoperative intervals were based on rating of scar appearance, color, width, height, and alignment by using a subjective, 5-point scar-assessment scale in which 1 indicated the poorest aesthetic appearance and 5, the ideal aesthetic appearance.

Results

A total of 58 pediatric patients who underwent cleft lip repair were evaluated; mean (SD) age at time of repair, 4.8 (3.0) months. Of these, 44 (76%) were male and 14 (24%) were female, 37 (64%) were white, 11 (19%) were black, 7 (12%) were Hispanic, 2 (3%) were Asian, and 1 (2%) was of another race/ethnicity. Scores on the Cohen κ interrater test indicated either a substantial or almost perfect strength of agreement among the physicians grading the scar outcomes. At 12 months, patients with black skin type had worse overall scar outcomes than patients with white skin type (odds ratio [OR], -0.31; 95% CI, -1.15 to -0.14; P = .03). A depressed scar height (OR, -0.54; 95% CI, -1.32 to -0.49; P < .001), and hypopigmented scar color (OR, -0.45; 95% CI, -1.34 to -0.32; P = .002) were associated with worse scar outcomes at 12 months following surgery. The overall median lip scar outcome significantly improved between the 6-month and 12-month follow-up assessments (scar-assessment scale score, 3.3; interquartile range [IQR], 2.7-4.0 vs 4.0; IQR, 3.3-4.3; P < .001). No association was observed between the anatomic type and severity of the cleft lip and scar outcomes (unilateral vs bilateral cleft, complete vs incomplete or microform cleft, and lip height ratio of the unilateral noncleft to cleft lip).

Conclusions and Relevance

This study's findings suggest that, compared with white pediatric patients, black pediatric patients exhibited worse overall scar outcomes. A depressed scar and a hypopigmented scar also were associated with overall worse scar appearance after surgical repair. Cleft lip scar outcomes were not significantly associated with the type and severity of the cleft lip.

Authors+Show Affiliations

Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31436786

Citation

Marston, Alexander P., et al. "Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip." JAMA Facial Plastic Surgery, 2019.
Marston AP, Costello MS, Farhood Z, et al. Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. JAMA Facial Plast Surg. 2019.
Marston, A. P., Costello, M. S., Farhood, Z., Brandstetter, K. A., Murphey, A. W., Nguyen, S. A., ... Patel, K. G. (2019). Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. JAMA Facial Plastic Surgery, doi:10.1001/jamafacial.2019.0669.
Marston AP, et al. Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. JAMA Facial Plast Surg. 2019 Aug 22; PubMed PMID: 31436786.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip. AU - Marston,Alexander P, AU - Costello,Mark S, AU - Farhood,Zachary, AU - Brandstetter,Kathleen A, AU - Murphey,Alexander W, AU - Nguyen,Shaun A, AU - Discolo,Christopher M, AU - Patel,Krishna G, Y1 - 2019/08/22/ PY - 2020/08/22/pmc-release PY - 2019/8/23/entrez PY - 2019/8/23/pubmed PY - 2019/8/23/medline JF - JAMA facial plastic surgery JO - JAMA Facial Plast Surg N2 - Importance: Scar outcomes following cleft lip repair are an important component of pediatric patient and family satisfaction and indicate the need for future surgical interventions. Objective: To assess the association of pediatric patient demographic factors and scar anatomic features with scar outcomes following cleft lip surgical repair. Design, Setting, and Participants: A case-control study was conducted involving 58 pediatric patients who underwent surgical repair of a cleft lip from October 31, 2008, to August 4, 2016, at a tertiary care pediatric specialty hospital. Data on patient demographic factors, cleft type, and the surgical technique used were collected and analyzed from June 11, 2009, to November 21, 2017. Scar outcomes were subjectively rated by 3 physicians at 6-month and 12-month postoperative intervals. Main Outcomes and Measures: Overall scar outcomes at 6-month and 12-month postoperative intervals were based on rating of scar appearance, color, width, height, and alignment by using a subjective, 5-point scar-assessment scale in which 1 indicated the poorest aesthetic appearance and 5, the ideal aesthetic appearance. Results: A total of 58 pediatric patients who underwent cleft lip repair were evaluated; mean (SD) age at time of repair, 4.8 (3.0) months. Of these, 44 (76%) were male and 14 (24%) were female, 37 (64%) were white, 11 (19%) were black, 7 (12%) were Hispanic, 2 (3%) were Asian, and 1 (2%) was of another race/ethnicity. Scores on the Cohen κ interrater test indicated either a substantial or almost perfect strength of agreement among the physicians grading the scar outcomes. At 12 months, patients with black skin type had worse overall scar outcomes than patients with white skin type (odds ratio [OR], -0.31; 95% CI, -1.15 to -0.14; P = .03). A depressed scar height (OR, -0.54; 95% CI, -1.32 to -0.49; P < .001), and hypopigmented scar color (OR, -0.45; 95% CI, -1.34 to -0.32; P = .002) were associated with worse scar outcomes at 12 months following surgery. The overall median lip scar outcome significantly improved between the 6-month and 12-month follow-up assessments (scar-assessment scale score, 3.3; interquartile range [IQR], 2.7-4.0 vs 4.0; IQR, 3.3-4.3; P < .001). No association was observed between the anatomic type and severity of the cleft lip and scar outcomes (unilateral vs bilateral cleft, complete vs incomplete or microform cleft, and lip height ratio of the unilateral noncleft to cleft lip). Conclusions and Relevance: This study's findings suggest that, compared with white pediatric patients, black pediatric patients exhibited worse overall scar outcomes. A depressed scar and a hypopigmented scar also were associated with overall worse scar appearance after surgical repair. Cleft lip scar outcomes were not significantly associated with the type and severity of the cleft lip. SN - 2168-6092 UR - https://www.unboundmedicine.com/medline/citation/31436786/Association_of_Pediatric_Patient_Demographic_Factors_and_Scar_Anatomic_Features_With_Scar_Outcomes_After_Surgical_Repair_of_Cleft_Lip L2 - https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2019.0669 DB - PRIME DP - Unbound Medicine ER -