Early Complications After Cleft Palate Repair

Deshpande, Gaurav; Campbell, Alex; Jagtap, Rasika; Restrepo, Carolina; Dobie, Hannah; Keenan, Henry Tait; Sarma, Hiteswar

doi:10.1097/scs.0000000000001113

Cited by 64 publications

(16 citation statements)

References 22 publications

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“…A 15-year study of the California Hospital Discharge data found comparable hospital charges (USD$19 346) for cleft palate surgery and an equivalent increase in LOS from complications. The overall literature complication rate of 3% to 4% is similar to the figure presented in our study (Deshpande et al, 2014;Mahboubi et al, 2015).…”

Section: Discussionsupporting

confidence: 90%

For Patients With Isolated Cleft Palate Does Revision Palatoplasty Have an Increased Risk of Inpatient Complication Compared to Primary Palatal Repair?

Lee

Halepas

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: The purpose of this study was to determine whether revision palatoplasty was associated with increased rates of inpatient complication and wound dehiscence compared to primary palatal repair. Materials and Methods: This was a retrospective study of patients with isolated cleft palate treated with primary palatoplasty or revision surgery for fistula repair. The records were obtained from the Kids’ Inpatient Database between 2000 and 2014. The primary predictor was the type of surgery, classified as either primary or revision palatoplasty. Secondary predictors included demographics and comorbidities. Primary study outcomes were the postoperative complication and dehiscence rates as noted during the hospitalization course. The secondary outcomes related to health care utilization as measured through length of stay (LOS) and hospital charges. Results: A total of 5357 total admissions (95.5% primary, 4.5% revision) were included in the final sample. Fistula repairs (odds ratio = 14.37, P < .01) had significantly greater odds of wound dehiscence. The rates of inpatient complication ranged from 3.5% to 3.7%, and there were no significant differences between primary and revision surgery ( P = .82). Complications were independently associated with insurance status and congenital anomalies. Complications and wound dehiscence both significantly increased the LOS and the hospital charges. Fistula repairs had a shorter mean LOS ( P = .02), however this did not translate into cost savings ( P = .60). Conclusions: Although the rates of inpatient complications were not significantly different, revision palatoplasty was associated with a greater odds of wound dehiscence. Failure of a primary repair may portend an increased risk of wound failure with subsequent surgeries.

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Section: Discussionsupporting

confidence: 90%

For Patients With Isolated Cleft Palate Does Revision Palatoplasty Have an Increased Risk of Inpatient Complication Compared to Primary Palatal Repair?

Lee

Halepas

et al. 2020

The Cleft Palate Craniofacial Journal

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“…Cleft surgery has been and is the largest, most sustained humanitarian global surgical effort to date, and successes in this discipline are helping to overcome the misconception that surgery is too difficult and costly in resource-poor regions (Singh, 2009;Campbell et al, 2014). Numerous recent studies have revealed that cleft care is cost-effective in both mission-based and center-based settings, and ongoing evaluations are showing the increased impact and improved outcomes achieved in sustainable settings (Uetani et al, 2006;Magee et al, 2010;Deshpande et al, 2014;Jansen et al, 2014). Operation Smile has developed a diagonal model of care delivery, in which cleft missions are initially used to provide care in a region while developing local surgical capacity to establish a more sustainable care delivery system.…”

Section: Discussionmentioning

confidence: 99%

Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

Park

Deshpande

Schönmeyr

et al. 2018

The Cleft Palate Craniofacial Journal

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Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons (P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

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“…Section of the vascular pedicle during the surgery has been associated with necrosis of the mucoperiosteal flap by some authors [ 2 , 4 ].…”

Section: Etiologymentioning

confidence: 99%

“…A multivariate analysis made in 709 patients by Deshpande et al found low rate of total or partial flap necrosis (less than 1%) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Flap Necrosis after Palatoplasty in Patients with Cleft Palate

Rossell-Perry

2015

BioMed Research International

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Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate.

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Early Complications After Cleft Palate Repair

Cited by 64 publications

References 22 publications

For Patients With Isolated Cleft Palate Does Revision Palatoplasty Have an Increased Risk of Inpatient Complication Compared to Primary Palatal Repair?

For Patients With Isolated Cleft Palate Does Revision Palatoplasty Have an Increased Risk of Inpatient Complication Compared to Primary Palatal Repair?

Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

Flap Necrosis after Palatoplasty in Patients with Cleft Palate

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