Number of Surgical Procedures for Patients With Cleft lip and Palate From Birth to 21 Years Old at a Single Children's Hospital

Background/Purpose: Pediatric patients with cleft lip and palate undergo numerous surgeries throughout their childhood and early adulthood to correct the aesthetic and functional stigmata of their diagnoses. This study identifies patient and clinical factors that contribute to the number of surgeries and anesthesia events children undergo for their cleft repair. Methods/Description: Retrospective chart review was performed using the genetic and dysmorphology database at Rady Children's Hospital San Diego. All patients with cleft lip or cleft palate diagnosis who underwent surgery at Rady Children's Hospital San Diego between 1988 and 2014 were included. A sample size of 71 patients was analyzed. Poisson regression was used to determine if there is a relationship between each variable of interest and the number of procedures. Results: For our sample of 71 patients, the average number of surgical procedures was 8.6 (SD, 4.4). The average number of anesthesia events was 6.7 (SD, 3.3). Across and within diagnosis, race and sex were not statistically significant factors in patients' number of surgeries. Patients with bilateral cleft lip and palate (BCLP) and unilateral cleft lip and palate had, on average, 10 and 9.4 procedures, respectively. This is in contrast to patients with unilateral cleft lip and isolated cleft palate who had, on average, 5.3 and 5.9 procedures, respectively. This difference was significant (P value = 0.01). Patients were also compared based on continuity of care. Patients who had their cleft surgeries by multiple plastic surgeons affiliated with our children's hospital had significantly more surgeries (P = 0.01). A surgical outlier subset of 17 patients (24%) was identified who had more than 10 surgeries. These patients also had, on average, 11.3 (unilateral cleft lip and palate) and 11.8 (bilateral cleft lip and palate) anesthesia events; this is in contrast to the nonoutliers who had, on average, 4.1 to 8 anesthesia events. Conclusions: This retrospective review identifies patient and clinical factors that contributed to the number of surgeries and anesthesia events that children with a cleft underwent from birth to adulthood at a single children's hospital. We found that "heralding" events, such as palatal fistula and multiple nasal or lip revisions, can put children at risk for an increasing-and perhaps deleterious-number of surgery and anesthesia events.