Predictors of Adverse Events Following Cleft Palate Repair in Nearly 5,000 Patients
Elbert J. Mets, BA, Fouad K. Chouairi, BS, Sina J. Torabi, BA, Michael Alperovich, MD.
Yale School of Medicine, New Haven, CT, USA.
PURPOSE: Cleft palate repair has rare, but potentially life-threatening risks. Understanding the risk factors for adverse events following cleft palate repair can guide surgeons in risk stratification and parental counseling. The present study seeks to characterize independent predictors of 30-day adverse events after primary cleft palate repair.
METHODS: Using data from the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2012 to 2016, patients who underwent primary cleft palate repair were evaluated. All patients in the database were followed by specially-trained nurses for 30 postoperative days, regardless of discharge status. Patients experiencing any adverse event, reoperation, readmission, or wound dehiscence (palatal fistula) were identified. For each adverse event, patient demographics, comorbidities, and surgical variables were compared between patients who did and did not experience the adverse event. Separate multivariate logistic regression analyses were performed for each of the adverse events to identify independent predictors. Each regression controlled for demographics, as well as surgical variables and comorbidities that differed significantly between patients who experienced adverse events and the remaining cohort.
RESULTS: 4,989 patients who underwent primary cleft palate repair with complete data were identified. Patients had a mean age of 1.0 ± 0.3 years, and 53.5% were male. A total of 6.4% (320 patients) experienced any adverse event with 154 patients (3.1%) experiencing wound dehiscence. Thirty-day readmission and reoperation rates were 2.7% and 0.9%, respectively. On multivariate analysis, perioperative blood transfusion (adjusted odds ratio [aOR] 30.4, 95% confidence interval [CI] 7.4-124.6) and bronchopulmonary dysplasia/chronic lung disease (aOR 2.1, 95% CI 1.1-4.0) were significantly associated with any adverse event, as was longer hospital length of stay in days (aOR 1.1, 95% CI 1.0-1.1; HLOS). Similarly, perioperative blood transfusion (aOR 270.3, 95% CI 63.2-1,156.6), and cerebral palsy (aOR 10.5, 95% CI 1.9-59.1) were found to be significantly associated with reoperation, as was longer HLOS (aOR 1.1, 95% CI 1.0-1.2). ASA class IV (aOR 4.5, 95% CI 1.1-19.0), bronchopulmonary dysplasia/chronic lung disease (aOR 2.4, 95% CI 1.1-5.2) and cerebral palsy (aOR 5.6, 95% CI 1.5-20.9) were significantly associated with readmission, as was HLOS (aOR 1.1, 95% CI 1.0-1.1). Perioperative blood transfusion (aOR 8.3, 95% CI 1.7-41.0) was significantly associated with wound dehiscence.
CONCLUSION: Adverse events following cleft palate surgery are rare. Systemic disease remains the greatest predictor for readmission and reoperation, while intraoperative adverse events requiring blood transfusion predispose patients to post-surgical complications.
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