Statewide Multicenter Analysis of the Incidence of Secondary Surgeries After Isolated Cleft Palate Repair

Introduction Previous smaller studies have reported a wide range, 15% to 45%, of secondary palate surgery. The goal of this study was to report the true incidence of secondary surgery derived from a large statewide database as well as study the timing and risk factors for secondary surgery. Methods Retrospective longitudinal analysis was performed of the 1995 to 2010 California Office of Statewide Health Planning and Development patient discharge database, which allows patients to be followed up over time. Patients were included in the study if they had an isolated palate diagnosis in addition to a primary repair code and excluded if they ever carried a cleft lip diagnosis or repair code. Results A total of 2616 isolated cleft palate patients were identified with a median follow-up of 8.0 years. At 16 years, the overall rate of second surgery was 13.6% with complete cleft palate patients having a higher rate of second surgery (15.92%) than the incomplete cleft palate patients (12.36%). The risk of second surgery over time showed a bimodal distribution; the first peak was seen in the first postoperative year and the second peak was seen 3 to 5 years postoperative. On multivariate regression, the only independent risk factor of a secondary surgery was uninsured status (HR, 4.55 [1.64-12.64]), whereas incomplete cleft palate (HR, 0.68 [0.46-0.98]) and Hispanic ethnicity (HR, 0.68 [0.50-0.94]) were found to be protective for secondary surgery with the rest of the covariates not showing significant association. Conclusions The incidence rate of secondary surgery (13.6%) at 16 years was less than reported in the literature. Patients who had a complete cleft palate repaired showed a higher incidence rate compared with those who had an incomplete cleft repaired, likely correlating with the complexity and invasiveness of the primary surgery. The first risk peak at which secondary surgeries were performed reflects the short-term complications that needed to be addressed within the first postoperative year. The second peak reflects the longer-term complications diagnosed at the age at which children reach speech milestones.