To Admit or Not to Admit: That is the Cleft Lip Question. Confirming the Safety of Outpatient Cleft Lip Repair

Abstract

Therapeutic, IV.

The Implications of Same-Day Discharge After Primary Unilateral Cleft Lip Repair: A National Surgical Quality Improvement Program-Based Study

“…2,6 Our findings are consistent with prior work evaluating the safety of ambulatory cleft lip repair in small, single-center studies, international settings and national databases. [4][5][6][7][8]21,27,28 However, our analysis augments existing literature in 2 key areas by focusing on discharge date rather than ''booking status.'' First, this approach enables our study to isolate perioperative outcomes in patients who go home the same day as surgery, whereas other studies do not.…”

“…Although surgical principles of cleft lip repair have undergone many iterations since first described by Millard, 19,20 from prolonged inpatient observation 7,9,21 to early discharge following surgery. This transition is in large part due to advances in pediatric medicine and anesthesia 22 as well as documented negative outcomes with hospital admission, 5,23 increasing cost with inpatient admission, 2,3 and changing reimbursement models. 6,21 By limiting admission of patients with minimal medical needs, resources and nursing care can be freed for more complex patients.…”

“…Though same-day discharge after cleft surgery has become more popular, 2–5,21 the safety of and indications for same-day discharge remain controversial. Many surgeons still opt for overnight admission for airway monitoring given the oral nature of the surgery and potential unpredictable complications associated with anesthesia in young infants 2,6,7,16,17,21 .…”

“…Though the traditional pathway of post-cleft lip repair has been to admit the patient overnight for observation, recent trends have popularized ambulatory cleft lip repair with same-day discharge 2–5 . Same day discharge has been demonstrated to be safe in single- or regional-center studies, 5–8 but generalizability remains questionable.…”

“…In 1992, standard perioperative cleft lip care called for 3 days of inpatient observation 9 . However, over the past decade, rates of ambulatory cleft lip repair have increased from 27% to 29% to nearly 50% to 80% at high volume centers that perform same-day discharge 2–5 . This trend has been ascribed to improvements in pain control as well as greater access to specialized care 10 .…”