Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery. Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity. Results: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity. Conclusion: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.

Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery.Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1.Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI % of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion:This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI.

We emphasize the benefits of a multidisciplinary team approach to the systemic management of patients with cleft lip and cleft palate (CL/CP) and their families. An ideal team offers support to families at each stage of their child's development and adapts to address new issues that are encountered throughout growth. We suggest the addition of a registered dietitian to the initial phase of the care team to ensure the child consumes adequate macronutrient intake, and to maximize growth and development. An ideal cleft palate care team focuses on a comprehensive, collaborative, and family‐centered approach to the complex medical and surgical needs of infants with CL/CP as they grow to young adulthood. Although care teams may differ slightly depending on context and location, there are central tenets that make an ideal team. After reviewing CL/CP care team guidelines and recommendations from a variety of different countries, this article reflects what an ideal organization structure and care team composition could be comprised of.

Objective To study the efficacy and safety profile of ketorolac in cleft palate surgery. Design Retrospective analysis of patients who underwent primary cleft palate surgery and received either postoperative ketorolac or opioids. Setting Tertiary care children's hospital. Patients, Participants Eighty-nine patients enrolled who were all younger than 36 months of age, not dependent on a gastrostomy tube, with no history of bleeding disorders, and had undergone their primary cleft palate procedure by one specific surgeon between January 2010 and June 2019. Interventions n/a. Main Outcome Measure Morphine equivalent dose (MED), Face, Legs, Activity, Cry, Consolability (FLACC) score, length of stay (LOS), total oral intake (mL), total oral intake/LOS, and postoperative adverse events between ketorolac and no ketorolac groups. Results MED, FLACC score, and LOS were significantly lower in the ketorolac group compared to the no ketorolac group. One patient in the ketorolac group had a bleeding event. Conclusions Use of ketorolac significantly decreased narcotic usage and pain scores as reported by the FLACC score. Moreover, postoperative bleeding was rare in both ketorolac and no ketorolac groups.