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

Abstract

Aim: Length of stay (LOS) is an important outcome measure of the Surgical Outcomes Monitoring and Improvement Program (SOMIP). After analyzing the outcomes of the first two SOMIP reports, we introduced the Palatoplasty Enhanced Recovery (PER) pathway for primary cleft palate repair in 2012. We aim to study if the implementation of PER pathway can decrease the LOS without increasing the complication rate. Methods: All children who underwent primary cleft palate repair from January 2008 to April 2015 were studied. PER pathway was introduced in January 2012. Demographics data, postoperative outcomes including the LOS, readmission, morbidity and oro-nasal fistula (ONF) were compared between patients operated before (pre-PER) and after (PER) the implementation of the pathway. Results: Eighty five children were recruited in the study (29 PER and 56 pre-PER). There were no statistical differences in the age, sex, type of cleft palate and associated syndrome between the two groups. Incidence of ONF (PER 13.8% vs pre-PER 8.9%, p = 0.490), morbidity (0% vs 5.4%, p = 0.204) and readmission (6.9% vs 3.6%, p = 0.493) were not statistically different. Median LOS (3 days vs 6 days, p < 0.0001) was significantly shorter in the PER group. Conclusions: The implementation of the PER pathway for primary cleft palate repair significantly decreased the length of stay without an increase in morbidity and readmission. The SOMIP initiated the establishment of the PER pathway and the positive outcome can be reflected in subsequent SOMIP reports.

Closing the Gap: A Systematic Review and Meta-Analysis of Enhanced Recovery After Surgery Protocols in Primary Cleft Palate Repair

“…Three studies (50%) reported on the rate of postoperative complications to assess patient safety (Supplementary Table 4). 13,15,20 There were no apparent differences in complication rates between cohorts across studies. However, the broad descriptions of complications between studies rendered pooled analysis unfeasible.…”

“…Ultimately, we included 6 studies for qualitative synthesis and 5 studies for quantitative synthesis (Table 1). 13,15,[19][20][21][22]…”

“…16 Four of the studies (66%) were conducted in the United States with 4 articles (66%) containing a prospective component. 13,15,[20][21][22] Five of the studies (83%) contained cohorts of only primary palatoplasty patients. 13,15,19,20,22 The No.…”

“…13,15,[20][21][22] Five of the studies (83%) contained cohorts of only primary palatoplasty patients. 13,15,19,20,22 The No. of patients undergoing primary cleft palate repair that underwent the ERAS and control protocols were 354 and 366, respectively.…”

Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

“…1). Following screening, 18 articles underwent full-text review and 5 studies [14][15][16][17][18] met final inclusion criteria. Upon initial review, 1 study was found to deliberately compare outcomes between controls and an ERAS group that was distinctly different with regards to demographics and medical history.…”