Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

Abstract

BackgroundIn 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs.MethodsAll live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated.ResultsWe identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007.ConclusionsBetween 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current recommendations. However, key outcomes, including facial appearance and speech, can only be assessed many years after the initial surgical treatment.

Effect of Hospital Volume on Outcomes of Surgery for Cleft Lip and Palate

“…Several studies have indicated that a higher surgeon volume is related to favorable outcomes in cleft surgery. [3][4][5][6] Another study has reported a relation between a higher surgeon volume and shorter duration of anesthesia. 13 However, the association between hospital volume and outcomes of cleft lip and palate surgery remains unclear.…”

“…Centralization results in a lower rate of corrective surgery, a shorter in-hospital stay, and standardization of the timing of surgery. 6,7 However, these studies did not account for possible effects of hospital volume or surgeon volume on the outcomes of surgery for cleft lip and palate because of their before-versus-after study design and limited adjustment for confounders. In addition, a few years after centralization, 1 study reported that surgeon volume did not affect the outcomes of cleft repair.…”

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child

“…This paper considers parent's perceptions of appearance and treatment outcomes in their 5-year-old child with cleft lip and palate Children born with a cleft lip and palate (CLP) undergo a number of procedures and surgical interventions during their first years of life, which are carried out to correct and improve oral function, speech, and facial appearance. Studies have quantified the burden of hospital care for children with CLP [2,3], and surgical treatment can be a frightening experience for a child [4]. Few, if any studies have, however, explored parents' perceptions of how their child cope with cleft surgery and treatment-related stress, while also comparing this information with registered postsurgical complications and surgical technique.…”

Épidémiologie des malformations associées aux fentes labiales et palatines à propos d’une étude rétrospective de 324 cas

“…La revue de la littérature concernant ces associations malformatives au sein de populations géographiquement et socioéconomiquement proches a rapporté des taux de 21 % en Angleterre sur une revue de 10 892 patients[8], 33 % en Italie dans une étude de 200 cas[11] et 36 et 34 % dans l'Est de la France respectivement au sujet de 207 patients[2] et 321 patients…”