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The Status of Cleft Lip Repair - An Assessment Using the 2012 ACS NSQIP Pediatric
Kaitlyn M. Paine, BM, Youssef Tahiri, MD, MSc, Ari M. Wes, BA, Jason D. Wink, BA, John P. Fischer, MD, MSc, CarolAnn H. Gelder, RN, MSN, Jesse A. Taylor, MD.
The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

BACKGROUND:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP Peds) is a prospectively collected 30-day quality improvement database that was recently made available in November 2013. Current literature regarding cleft lip surgery employs single-institution data; this study utilizes the NSQIP Peds to identify risk factors and better understand national readmission and complication rates for cleft lip.
METHODS:
Patients undergoing Current Procedural Terminology codes 40700, 40701, and 40702 were extracted from the ACS NSQIP Peds 2012 Pediatric Participant User File Database (2012 PUF). Patients older than 36 months, or with an additional surgery that may have confounded the risk of surgery, were excluded. A complication variable was created from a composite of outcome variables within the database. Complications were then compared using Fischer’s exact and chi-squared tests, as well as, rank-sum. A subgroup analysis was performed for those who underwent ambulatory cleft lip surgery.
RESULTS:
Of the 525 patients included, 4.2% had complications, with respiratory complications being the most common. Risk factors included ventilator dependence (p=0.002), oxygen support (p=0.016), tracheostomy (p=0.005), esophageal/gastric/intestinal disease (p=0.007), impaired cognitive status (p=0.034), acquired CNS abnormality (p=0.040), nutritional support (p=0.001), major and severe cardiac risk factors (p=0.011 and p=0.005), and an ASA score of
3 (p=0.002). In addition, complications were associated with undergoing a one stage bilateral repair (p=0.045) or concomitant ENT procedure (p=0.0450). The readmission
rates between ambulatory and inpatient were 2.6% and 4.9% (p=0.556), with an overall readmission of 4.6%. Ambulatory patients were older (p=0.005) and had shorter operative times (p<0.001).
CONCLUSIONS:
Peri-operative complications are low following cleft lip repair, with respiratory complications being the most common. Readmission rates of 4.6% are higher than expected, and insight into predictors of complications will allow surgeons to identify patients who could benefit from additional resources.


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