Comparison of Outcomes after Palatoplasty between Patients with Isolated Cleft Palate, and Cleft Lip and Palate: A Propensity-Score Matched Analysis
Elbert J. Mets, BA, Fouad K. Chouairi, BS, Sina J. Torabi, BA, Michael Alperovich, MD.
Yale School of Medicine, New Haven, CT, USA.
Described in 1931, the Veau classification of orofacial clefts distinguishes patients with isolated cleft palate (Veau I-II, CP) and those with cleft lip and palate (Veau III-IV, CLP). Previous studies have suggested a positive association between Veau classification and the risk of complications after cleft palate repair. However, no studies to date have leveraged large national databases to evaluate the effect of Veau classification on outcomes after palatoplasty. In a propensity-score-matched analysis, the present study sought to compare 30-day outcomes after palatoplasty between patients with isolated CP (Veau I-II) to those with CLP (Veau III-IV).
Patients in the National Surgical Quality Improvement Pediatric (NSQIP-P) database from 2012 to 2016, undergoing cleft palate repair were identified. Patients whose dichotomized Veau classification (I-II vs. III-IV) could be determined using CPT, and ICD-9 and -10 codes were included in the study. Patient demographics, comorbidities, and surgical variables were compared between patients with isolated CP (Veau I-II) and those with CLP (Veau III-IV). Patients with isolated CP were propensity-score matched to patients with CLP. Patients were matched on age, sex, BMI, surgeon's specialty, cleft laterality (uni- vs. bilateral), and ASA class. Patients isolated in propensity-score matching with isolated CP were compared to those with CLP for demographics, comorbidities, surgical variables, and 30-day adverse events. Controlling for age, sex, BMI, and ASA class, as well as for comorbidities and surgical variables that differed between groups, separate multivariate logistic regression analyses were created to evaluate the effect of CP/CLP on any, surgical, and medical adverse events, reoperation, and readmission.
4,079 patients undergoing palatoplasty, with complete data, were identified.Propensity-score matching isolated 1,284 patients, evenly divided between those with isolated CP and CLP. Matched patients were aged 1.0 ± 0.3 years, and 53.0% were male. In the propensity-score-matched cohort, 30-day adverse events were statistically indistinguishable between patients with isolated CP and CLP clefts, including the rates of palatal fistula (3.4% vs. 4.4%, p = 0.387). Additionally, in multivariate analysis, CP/CLP did not predict any, surgical, or medical adverse events, reoperation, or readmission.
In a propensity-score-matched analysis, comparing patients undergoing palatoplasty with isolated cleft palate and cleft lip and palate, the present study identifies no difference in 30-day adverse events by cleft type (CP vs. CLP). The results of the present analysis can be used to inform management of patients undergoing palatoplasty.
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