Implement of Palatoplasty Enhanced Recovery (PER) pathway for cleft palate repair after the audit from the Surgical Outcomes Monitoring and Improvement Program (SOMIP)

2016 ◽  
Vol 20 (2) ◽  
pp. 61-65
Author(s):  
Edwin Kin-Wai Chan ◽  
Kim-Hung Lee ◽  
Vicky Hei-Yi Wong ◽  
Bess Siu-Yan Tsui ◽  
Sammi Yuen-Shan Wong ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Surgical Outcomes ◽  
Enhanced Recovery ◽  
Improvement Program ◽  
Cleft Palate Repair ◽  
Palate Repair

Impact of Cardiac Risk Factors in the Postsurgical Outcomes of Patients With Cleft Palate: Analysis of the 2012-2014 NSQIP Database

2018 ◽  
Vol 56 (5) ◽  
pp. 595-600 ◽  
Author(s):  
Christopher J. Goodenough ◽  
Kathryn T. Anderson ◽  
Kari E. Smith ◽  
Robert A. Hanfland ◽  
Nitin Wadhwa ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cardiac Disease ◽  
Cardiac Risk ◽  
Safe Procedure ◽  
Improvement Program ◽  
National Cohort ◽  
Cleft Palate Repair ◽  
Forward Logistic Regression ◽  
Palate Repair ◽  
Postsurgical Outcomes

Objective: To assess the risk of complication in patients undergoing cleft palate repair with congenital cardiac comorbidities in a large, national cohort. Design: Retrospective review. Patients/Setting: Using the 2012-2014 National Surgical Quality Improvement Program (NSQIP) Pediatric database, patients undergoing cleft palate repair were selected for analysis. Patients with cleft palate repairs were stratified based on the presence or absence congenital cardiac comorbidities. Univariate and stepwise forward logistic regression were conducted. Main Outcome Measures: It is hypothesized that risk of postoperative adverse events in patients with congenital cardiac comorbidities is higher than in patients without cardiac disease. Results: Nationally, between 2012 and 2014, 3240 patients underwent cleft palate repair, 422 (13.0%) with cardiac disease, and 2818 (87.0%) without cardiac disease. Patients with cardiac disease were smaller (10.5 [6.6] kg vs 11.6 [8.6] kg, P < .01) and more likely to be premature (4.6% vs 13.0%, P < .01) compared to those without cardiac disease. Postoperatively, patients with cardiac conditions were more likely to experience an adverse event (8.8% vs 4.2%, P < .01). Specifically, they were more likely to experience reintubation (1.7% vs 0.4%, P < .01), reoperation (2.1% vs 0.6%, P < .01), and longer length of stay (2.7 [7.0] vs 1.6 [2.8] days, P < .01). Rates of surgical site infection and dehiscence were not different. Conclusions: Cleft palate repair in patients with concurrent congenital cardiac defects is a safe procedure but carries elevated risk in the postoperative period as demonstrated in this analysis of the NSQIP-Pediatric database. Technical risks are equivalent. Additional anesthesia and surgical awareness of these potential complications is essential to minimize perianesthesia risks.

Optimal Timing of Palatoplasty in Infants With Comorbidities

2020 ◽  
pp. 105566562097624
Author(s):  
Christopher L. Kalmar ◽  
Vijay A. Patel ◽  
Zachary D. Zapatero ◽  
Mychajlo S. Kosyk ◽  
Jesse A. Taylor
Keyword(s):  
Adverse Events ◽  
Cleft Palate ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Optimal Timing ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: Ideal timing of palatoplasty continues to be debated given that early repair is thought to improve speech and hearing, whereas delayed repair is associated with less midface growth disruption. The purpose of this study is to elucidate optimal timing of palatoplasty in patients with comorbidities to mitigate perioperative complications. Design: Retrospective cohort study. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program Pediatric. Patients: Palatoplasty performed for children younger than the age of 2 years with comorbidities. Outcomes: Medical/surgical complications, reoperations, readmissions within 30 days postoperatively. Results: Patients with comorbidities having Veau I or II cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 125 days of age ( P < .001). Patients with comorbidities having Veau III cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 225 days of age ( P = .010). Patients with comorbidities having Veau IV cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 250 days of age ( P = .045). Conclusions: Infants with comorbidities having progressively increasing Veau classification demonstrate unique age-dependent perioperative thresholds, such that more extensive phenotypes are associated with better perioperative outcomes with older age at time of cleft palate repair.

Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care

2020 ◽  
Vol 32 (1) ◽  
pp. e72-e76
Author(s):  
Joseph K. Moffitt ◽  
Alfredo Cepeda ◽  
Rhashedah A. Ekeoduru ◽  
John F. Teichgraeber ◽  
Phuong D. Nguyen ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Transition Of Care ◽  
Cleft Palate Repair ◽  
Palate Repair

Speech and Surgical Outcomes in Children With Veau Types III and IV Cleft Palate

2017 ◽  
Vol 55 (3) ◽  
pp. 396-404 ◽  
Author(s):  
Mitchell A. Pet ◽  
Ryan Dodge ◽  
Babette Siebold ◽  
Sara Kinter ◽  
Jonathan Perkins ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Surgical Outcomes ◽  
Tertiary Care ◽  
Oronasal Fistula ◽  
Air Emission ◽  
International Adoptees ◽  
Cleft Palate Repair ◽  
Relative Delay ◽  
Palate Repair ◽  
Study Setting

Objective: This study compares speech and surgical outcomes in internationally adopted and nonadopted patients undergoing cleft palate repair, and examines the influence of age at initial palatoplasty. Design: Retrospective cohort study setting: Tertiary Care Children’s Hospital. Patients: 70 international adoptees and 211 nonadoptees with Veau type III and IV clefts (without associated syndrome) repaired at our institution. Outcome Measures: Outcomes included VPI, compensatory misarticulations, intelligibility, nasal air emission, oronasal fistula, and secondary speech surgery. Speech evaluations completed near 5 years of age were gathered from a prospectively collected database. Results: Adoptees underwent palatoplasty 5.2 months after arrival, a mean of 10.4 months later than nonadoptees. Adoptees were significantly more likely to develop moderate/severe VPI and trended toward more frequent need for secondary speech surgery. Oronasal fistula occurred at similar rates. Increased age at initial palatoplasty was a significant predictor of moderate to severe VPI, and need for secondary speech surgery. Conclusions: International adoptees undergo palatoplasty 10.4 months later than nonadoptees and are significantly more likely to develop moderate/severe VPI, with a trend toward increased secondary speech surgery. An association between treatment delay and moderate/severe VPI and secondary speech surgery has been demonstrated. While a causal relationship between delayed repair and inferior outcomes in international adoptees has not been proven, this data suggests that surgical intervention upon unrepaired cleft palates soon after adoption may be beneficial. The opportunity for a change in practice exists, as half of the 10.4-month relative delay in palate repair occurs postadoption.

Adult Quality of Life Post Cleft Palate Repair

2017 ◽  
Vol 28 (4) ◽  
pp. 909-914
Author(s):  
Rachel Skladman ◽  
Lynn Marty Grames ◽  
Gary Skolnick ◽  
Dennis C. Nguyen ◽  
Sybill D. Naidoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

2021 ◽  
pp. 105566562110174
Author(s):  
Thomas R. Cawthorn ◽  
Anna R. Todd ◽  
Nina Hardcastle ◽  
Adam O. Spencer ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cleft Palate ◽  
Care Pathway ◽  
Clinical Care ◽  
Oral Intake ◽  
Opioid Consumption ◽  
Complication Rates ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

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