Clinical Practice Patterns And Evidence-based Medicine In Unilateral Cleft Lip Repair: A Sixteen-year Review Of Maintenance Of Certification Tracer Data From The American Board Of Plastic Surgery
Nikhil D. Shah, BS1,2, Aaron M. Kearney, MD1,2, Arun K. Gosain, MD2.
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
PURPOSE: The American Board of Plastic Surgery (ABPS) began collecting data from unilateral cleft lip (UCL) corrections in 2014 as a component of the Maintenance of Certification (MOC) process. We evaluated these data to understand practice patterns in UCL, in the United States, and whether these practice patterns had changed over the past five years.
METHODS: Cumulative tracer data for unilateral cleft lip correction were reviewed from its inception in 2014 through April 2016 and September 2019. Evidence-Based Medicine (EBM) articles addressing UCL published in Plastic and Reconstructive Surgery (PRS) in 2013, 2014, and 2017 were reviewed and the results of the MOC tracer data were categorized as follows: 1) Pearls: Topics addressed by the EBM articles and tracer data; 2) Topics covered by EBM articles and not in the tracer; 3) Topics covered in the tracer but not mentioned in EBM articles.
RESULTS: Cumulative data through 2016 consisted of 220 cases, and through 2019 consisted of 460 cases. In 2019, 53% of cases were complete unilateral cleft lip and 40% were incomplete. The median age at time of surgery was 4 months (range: 1-216). The most frequently used procedures were the Millard rotation advancement (50%), followed by the Mohler (11%), and straight line/variant (10%). Over 90% of patients experienced no complications postoperatively. Revisions were the most common post-operative adverse event (2%) (Table 1). Nasal alveolar molding (NAM) was used in 24% of cases and 53% of cases underwent a concurrent primary cleft rhinoplasty. Absorbable sutures were used for skin closure in 72% of cases and arm restraints in 65%. No significant differences were found in these statistics when cumulative data through 2016 were compared with those through 2019. There was a significant decrease in the rate of gingivoperiosteoplasty performed at the time of primary cleft lip repair from 2016 (10%) to 2019 (6%; p=0.083).
CONCLUSION: A review of the unilateral cleft lip tracer data allows surgeons to compare their practice with national trends and published evidence-based medicine. Our analysis demonstrates that only half of the patients in the United States received a primary cleft rhinoplasty at the time of cleft lip repair. The rate of gingivoperiosteoplasty at the time of primary UCL repair is decreasing and may be related to a lack of Evidence-Based Medicine supporting this procedure. ABPS tracer data provides a national, cleft lip-specific database with longer follow-up times than other large databases.
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