Cleft Palate Surgery

Abstract

INTRODUCTION: Cleft palate repair is a widely performed pediatric surgery yet rates of common peri-operative morbidities remain unclear. This study examines a national sample of patients to assess peri-operative outcomes for cleft palate repair as well as hospital factors impacting quality and patient safety. Specifically, this study evaluates whether pediatric hospitals use fewer resources and potentially provide better quality care. METHODS: Data were obtained from the Kids Inpatient Database from 1997, 2000, 2003, and 2006. Cohort was identified using the ICD-9-CM procedure code for cleft palate surgery (27.62). We examined patient age, race, sex, insurer, and comorbidities. Hospitals types included Pediatric Hospitals, General Hospitals, and Non-accredited Children's Hospital (NAPH). Quality measures were mean length of stay (LOS), extended mean LOS (LOS>2), and complications. Quality measures were assessed by age groups <9 months, 9-12 months, >12 months. RESULTS: 14,153 patients had cleft palate repair with mean LOS of 2 days (SD 0.04), mortality rate of 0.01%, and transfusion rate of 0.3%. Less than 3% of children experienced a complication during their hospital stay. Complication rates did not vary with age but quadrupled in those with LOS>2 days. Comorbidities increased odds of LOS>2 by 2.7 times; comorbidities were highest in Pediatric Hospitals yet those cared for in non-pediatric hospitals had 4.3 times higher odds of LOS>2. Median total charges was $10,835 and increased to $15,104 with LOS>2; median total costs was $4,367, but increased to $6,148 with LOS>2. CONCLUSION: Cleft palate surgery has low mortality and acute complications. Pediatric Hospitals had higher comorbidities yet shorter LOS and fewer patients with LOS>2 than General Hospitals and NAPH. Total charges and costs nearly doubled with LOS>2. Additional research is needed to understand pediatric hospital resources associated with lower LOS, and thereby lower costs. DISCLOSURES: This study was supported in part by the Medical Scholars Program from Stanford University School of Medicine, grant number TLI RR025742 from Stanford NIH/NCCR CTSA, VA RR&D Career Development Award (to Catherine Curtin, MD), and grant number K01HS018558 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs, Stanford University or the Agency for Healthcare Research and Quality.