Six-year burden of care for non-syndromic unilateral cleft lip and palate patients: A comparison between cleft centers and non-cleft centers
Pierce Janssen, MD, Gabriel Klein, MD, Kanad Ghosh, BS, Wei Hou, PHD, Christopher Bellber, MD, Alexander Dagum, MD.
Stony Brook Medicine, Stony Brook, NY, USA.
BACKGROUND: The American Cleft Palate-Craniofacial Association (ACPA) has accredited numerous facilities as cleft palate and craniofacial care centers across the continental United States. Nevertheless, cleft-specific primary and secondary procedures are still performed at non-accredited centers. The purpose of this study was to examine total number of admissions, operations, and cleft-specific procedures for non-syndromic unilateral cleft lip and palate patients, and to compare outcomes between New York cleft palate centers and non-cleft centers.
METHODS: This retrospective study was based off the New York Statewide Planning and Research Cooperative System (SPARCS), a database that documents hospital admissions using ICD-9 and CPT coding. Our study included all patients with at least six years of follow-up who underwent both cleft lip and palate repair in New York from January 2001 to December 2014. Exclusion criteria included ICD-9 codes indicating any of 42 common syndromes associated with cleft defects. Total number of admissions, cleft operations, and cleft-specific procedures were compared between New York cleft centers and non-cleft centers.
RESULTS: 198 patients were included in this study. 111 patients were treated at cleft centers and 87 at non-cleft centers. Age at primary lip repair was significantly lower in cleft centers (mean = 161 days, 5.4 months) than non-cleft centers (mean = 201 days, 6.7 months), p=.0373. There was no significant difference between age at primary palate repair in cleft centers (mean = 304 days, 10.1 months) and non-cleft centers (mean = 313 days, 10.4 months), p=.6669. Number of hospital admissions was significantly higher at non-cleft centers versus cleft centers (2.77 and 2.23, respectively), p=.0068, as was the case for number of cleft-specific procedures (4.95 and 4.30, respectively), p=.0304. There was no significant difference in number of cleft operations at non-cleft centers versus cleft centers (2.15 and 1.89, respectively), p=0.0557.
CONCLUSIONS: Surgical management of patients with cleft defects varies considerably among surgeons, care centers, and geographical locations. This data demonstrates statistically significant differences between New York cleft centers versus non-cleft centers for surgical management during the first six years of life in non-syndromic unilateral cleft lip and palate patients. Patients operated on at non-cleft center experienced significantly higher total number of hospital admissions and cleft-specific procedures. On average, patients at non-cleft centers also underwent primary lip repairs at an older age than those at cleft centers. There seems to be notable differences in surgical decision-making and overall burden of care when comparing cleft centers to non-cleft centers.
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