Discharge Practices, Readmission, and Serious Medical Complications following Primary Cleft Lip Repair in 23 U.S. Children’s Hospitals

Hopper, Richard A.; Lewis, Carol; Umbdenstock, R.; Garrison, Michelle M.; Starr, Jacqueline R.

doi:10.1097/prs.0b013e3181a0746e

Cited by 41 publications

(40 citation statements)

References 9 publications

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“…Three studies 19,33,34 were included in otolaryngology, 2 focusing on tracheotomy and 1 on cleft lip repair. Both tracheotomy articles considered only hospital volume, and the study on cleft lip repair evaluated both surgeon and hospital volume.…”

Section: Otolaryngology or Craniofacial Surgerymentioning

confidence: 99%

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

McAteer¹,

LaRiviere²,

Drugas³

et al. 2013

JAMA Pediatr

123

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Importance: Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.Objective: To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.Evidence Review: A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted.Findings: Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures.Conclusions and Relevance: Data on experiencerelated outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies should seek both to standardize definitions, making results more applicable, and to differentiate procedures affected by surgeon experience from those more affected by hospital resources and system-level variables.

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Section: Otolaryngology or Craniofacial Surgerymentioning

confidence: 99%

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

McAteer¹,

LaRiviere²,

Drugas³

et al. 2013

JAMA Pediatr

123

View full text Add to dashboard Cite

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“…36 The length of stay after repair of cleft palate can be affected by hospital type and setting, surgeon experience and volume, and patient-family resources. 2 Compared to general hospitals and nonaccredited children's hospitals, pediatric hospitals demonstrated a significantly shorter length of stay, despite treating patients with more comorbidities. 31,36 Teaching hospitals, historically considered to be more costly compared with nonteaching hospitals, 36,37 are comparable to their nonteaching counterparts.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Need for Routine Admission following Primary Cleft Palate Repair

Wood

Boyajian

Zurakowski

et al. 2015

Plastic and Reconstructive Surgery

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“…Integral to any changes in traditional practices of patient care is a careful scrutiny of outcomes from a quality and safety perspective. Due to a change in inpatient duration of hospital stay through the 1980s, a series of audits regarding the complication rates of short-stay were performed (7)(8)(9)(10)(11)(12)(13). These authors suggested no significant complications were found with shorter hospital stays.…”

Section: Resultsmentioning

confidence: 99%

“…A multicentre study analyzing cleft lip repair discharge practices involving 2558 patients over a five-year period was performed by Hopper et al (10) and revealed that 72% of patients were being managed with an overnight inpatient stay postoperatively. On review of ambulatory outcomes, compared with inpatient stay outcomes, these authors found no significant differences between the groups and concluded that serious postoperative medical complications occurred rarely (1.1%), and that readmission to hospital was a rare event (1.88%).…”

Section: Resultsmentioning

confidence: 99%

“…With this change in practice toward day-of-surgery admissions and shorter postoperative stays, the overall duration children were admitted to hospital was dramatically reduced. However, despite a subtle trend toward day-of-surgery discharge or ambulatory surgery for cleft lip repair, the great majority of centres continue to admit children postoperatively (10).…”

Section: Evolution Of Ambulatory Surgerymentioning

confidence: 99%

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Ambulatory cleft lip surgery: A value analysis

Arneja

Mitton²

2013

Canadian Journal of Plastic Surgery

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Background Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. Objectives To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. Methods A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. Results On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. Conclusions The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory cleft surgery enhances overall health care value.

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Discharge Practices, Readmission, and Serious Medical Complications following Primary Cleft Lip Repair in 23 U.S. Children’s Hospitals

Abstract: A number of factors related to the hospital, surgeon, patient, and patient's family bear consideration in deciding the timing of discharge after primary cleft lip repair. The most clinically important factor appears to be the overall preexisting medical status of the patient.

Cited by 41 publications

References 9 publications

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

Evaluating the Need for Routine Admission following Primary Cleft Palate Repair

Ambulatory cleft lip surgery: A value analysis

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