PC17. Implementation of an Enhanced Recovery after Surgery Protocol for Cleft Palate Repair

Abstract

PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cleft surgery, to decrease hospital stays and improve outcomes. The authors aim to describe the implementation of an ERAS protocol for cleft palate repair at a tertiary care hospital. METHOD: Patients undergoing cleft palate repair at the authors’ institution over a 10-year period were collected (n=242). Cleft demographics and operative details were collected. Primary outcome measures were hospital length of stay (LOS) and narcotic usage. Secondary outcome measures were fistula development and need for speech surgery. Chi-square tests and independent t-tests determined significance. RESULTS: Infiltration with bupivacaine was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased hospital LOS (p < 0.01). Utilization of the Furlow palatoplasty was associated with decreased hospital LOS (p < 0.01). Patients using the ERAS protocol experienced shorter LOS (p < 0.01). Fistula development was associated with increased 24-hour morphine equivalent usage (p < 0.01). Need for speech surgery was associated with increased 24-hour morphine equivalent usage (p < 0.01) and increased hospital LOS (p < 0.05). CONCLUSION: This study reiterates the benefit of an ERAS protocol for patients undergoing cleft palate repair. The protocol resulted in decreased LOS and narcotic use. The finding regarding fistula formation and need for speech surgery requiring increased narcotics may indicate that the initial postoperative period is vital to adequate wound healing and subsequent outcomes. This study has implications for ways to maximize hospital reimbursement, as well as potentially improve outcomes.