Effect of Cleft Palate Repair Timing on Inpatient Complication Rate: Review of a National Database

Objectives:Timing of cleft palate repair is controversial. We aim to assess whether timing of cleft palate repair affects rates of inpatient complications, length of stay (LOS), and cost of stay.Methods:The Healthcare Cost and Utilization Project Kids' Inpatient Database 2009 was queried for all admissions with a primary diagnosis of cleft palate during which cleft palate repair was performed as a primary procedure. Age 6 months or less was termed "early" repair, while age >6 months was termed "standard" repair. Patients age >3 years old, inpatient stays >30 days, and those stays in which a cleft lip repair was performed were excluded. Logistic regressions were used to model the probability of complications. Generalized linear models and a natural log link function were used for LOS and hospital charges, using SAS 9.4.Results:We included 223 early and 1482 standard repair patients. Early repairs were exclusively performed in urban hospitals (P<0.001). Eighty-nine patients experienced a total of 100 complications, including respiratory failure (N=53), airway obstruction (N=18), and oropharyngeal hemorrhage (N=13). We found no significant difference in complication rate or total hospital charges in the 2 groups. The earlier repair group had a slightly longer LOS (P=0.048).Conclusion:Over 85% of United States cleft palate repairs are performed after 6 months of age. All early repairs were performed at urban hospitals, and had slightly longer LOS. There was a 5.1% overall complication rate. Available data revealed no significant difference in complication rates between early repair and standard repair groups.Level of Evidence:3b.