The Early Operative Burden for Children Born with Cleft lip and Palate

Abstract

Objectives to audit the surgical management of infants born with non-syndromic cleft lip and palate (CLP) at an Australian cleft unit in a large tertiary paediatric hospital Design Retrospective cohort study. Setting A tertiary Cleft centre. Patients 193 infants born with non-syndromic CLP were referred to the centre and underwent primary repair of their CLP between 2009 and 2020. Main Outcome Measures: (1) The timing and surgical repairs performed; (2) the frequency of postoperative complications; (3) the frequency of secondary Cleft surgery; and (4) the total Cleft-related operations performed for infants born with CLP. Results Four different surgical repair techniques were performed by six surgeons, and postoperative complications were uncommon (n = 14). Rates of oronasal fistula surgery (10.5% at five years of age; 14.3% at eight years of age) and velopharyngeal insufficiency surgery (8.7% at five years of age; 14.3% at eight years of age) were not significantly different across the surgical repair groups (p-value >0.05) and were comparable to international Cleft centres. Children underwent an average of four operative procedures in this audit period, including primary Cleft repair, ear, nose and throat surgery, and dental care. Surgery for managing Eustachian tube dysfunction was the most common surgical intervention following primary Cleft repair. Conclusions Children born with non-syndromic CLP have a high early operative burden, with outcomes similar across the spectrum of techniques and surgeons.

Surgeons' perspectives on operation report documentation

“…Narrative and synoptic operation reports were used from two patient groupsthe traditional and Oslo repair groups-from a retrospective cohort study at a single quaternary cleft centre from 2009 to 2019. 2 Surgeons used narrative operation report writing until a synoptic proforma was introduced in 2016 (see Supplementary Data S1). The methodology and interview questions were workshopped by interviewing two fellows to determine a reasonable number of operation reports that could be reviewed in a single interview, striking a balance between the number of reports discussed and the opportunity to explore each in depth.…”

“…To understand the consultant surgeons' perspectives on operation report writing, five plastic and reconstructive surgeons who specialize in cleft surgery reviewed cleft palate repair operation reports for the quality and completeness of documentation. Narrative and synoptic operation reports were used from two patient groups—the traditional and Oslo repair groups—from a retrospective cohort study at a single quaternary cleft centre from 2009 to 2019 2 . Surgeons used narrative operation report writing until a synoptic proforma was introduced in 2016 (see Supplementary Data S1).…”

“…We completed a retrospective cohort study of patients born with non-syndromic cleft lip and palate (CLP) at a single quaternary centre and found significant differences in the quality of operation report documentation. 2 At times, the operation reports were so brief that we could not determine what surgical repair techniques were performed. This led to difficulties in answering key research questions in cleft, such as what surgical repair may produce better patient outcomes.…”