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

Abstract

Orofacial clefts are the most common craniofacial anomaly observed in the United States. Permitted by recent advancements in anesthesia and multimodal pain management, there has been a trend toward outpatient cleft lip repair to alleviate hospital burden and minimize healthcare costs. The purpose of this study was to compare complication rates between outpatient and inpatient cleft lip repair from large national samples as well as identify preoperative factors that predicted discharge status. The National Surgical Quality Improvement Program database for pediatrics was used to analyze 30-day outcomes for all patients undergoing cleft lip repair (CPT (current procedural terminology) code 40700) from 2012 to 2019. Complication rates were compared across 3 groups: same day discharge, next day discharge, and later discharge. Preoperative factors, including comorbidities and demographics, were analyzed to determine the impact of discharge date on complications as well as identify independent predictors of discharge timing and perioperative complications. A total of 6689 patients underwent primary cleft lip repair, with 16.8% discharging on day of surgery, and 72.4% discharging 1 day after surgery. Complication rates were statistically equivalent between same day and next day discharge. Preoperative factors predicting complication and postoperative admission included age <6 months and weight less than ten pounds at the time of surgery. Patients discharged after more than 1 day in the hospital had higher rates of complications as well as more preoperative comorbidities. Complication rates between same day and next day discharge are equivalent, suggesting that same day discharge is a safe option in select patients. Clinical judgment is critical in making these decisions.