Outpatient Versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications

Background: Fiscal constraints are directing healthcare systems towards shorter patient hospital lengths of stay. Outpatient primary cleft lip surgery (PCLS) has been shown to be safe but outpatient primary cleft palate surgery (PCPS) remains controversial. This study evaluates 30-day postoperative complications associated with PCLS and PCPS. Methods: The American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-Pediatric) database was used to identify patients undergoing PCLS and PCPS between 2012 and 2015. Patient demographic and clinical factors, as well as 30-day complications were compared between outpatient versus inpatient PCLS and PCPS. Chi-square, t-tests and multivariate regression were performed. Results: 3,142 patients were included in the PCLS group and 4,191 in the PCPS group. Patients in the PCLS group with underlying structural pulmonary abnormality had significantly longer hospital lengths of stay (B = 4.94; 95% CI: 2.21-7.66; p=0.001). In the PCPS group, patients undergoing outpatient surgery has a significantly higher risk of superficial wound dehiscence (OR = 1.99; 95% CI: 1.22-3.24; p=0.01), deep wound dehiscence (OR = 2.22; 95% CI: 1.25-3.95; p=0.01) and at a significantly lower risk of reoperation (OR = 0.36; 95% CI: 0.14-0.96; p=0.04) and readmission (OR = 0.52; 95% CI: 0.31-0.88; p=0.02). Conclusions: Outpatient PCLS is safe and has a similar perioperative complication profile as inpatient surgery. Outpatient PCPS is a common practice in many US hospitals and has a significantly higher rate of wound complications and lower rates of reoperation as well as readmission. In properly selected patients, outpatient palatoplasty can be safely performed. We have no financial relationships to disclose. Primary Cleft Lip and Palate Surgery Outcomes Disclaimer The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Corresponding author: Roberto L. Flores, MD, Director of Cleft Lip & Palate Program, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 305 E 33rd Street, New York City, NY, 10016, U.S.A., Roberto.Flores2@nyumc.org, T: (212) 263-3704, F: (212) 263-8494 ©2018American Society of Plastic Surgeons