Cleft lip repair: are outcomes between unilateral and bilateral clefts comparable?

Abstract

This study sought to compare patient demographics, operative course, and peri-operative outcomes between unilateral and bilateral cleft patients. Primary cleft lip repairs were isolated from the National Surgical Quality Improvement Program Pediatric Database (NSQIP-P). Unilateral and bilateral cases of primary cleft lip were identified by ICD codes. Demographics, comorbidities, and post-operative outcomes were compared between cohorts. Patients were propensity matched to control for differences before repeating the analysis. About 4550 cleft lip repairs were evaluated over the 5-year period. Of the cases where the cleft type was identifiable, 75.5% were unilateral clefts and 24.5% were bilateral clefts. The bilateral cleft population had significantly more comorbidities including higher rates of ventilator dependence (1.0% versus 0.4%, p = 0.02), asthma (1.6% versus 0.7%, p = 0.011), tracheostomy (1.6% versus 0.5%, p < 0.001), gastrointestinal disease (16.9% versus 12.7%, p < 0.001), previous cardiac surgery (3.6% versus 2.2%, p = 0.015), developmental delay (9.9% versus 4.6%, p < 0.001), structural central nervous system abnormalities (5.0% versus 2.5%, p < 0.001), and nutritional support (8.0% versus 3.2%, p < 0.001). Following propensity matching, there were no significant differences in complications, readmissions, or reoperations between the cohorts. Patients with bilateral cleft lip have significantly more comorbidities than unilateral cleft lip patients. However, peri-operative outcomes are comparable between the groups.

Keywords:

• Cleft lip
• unilateral
• bilateral
• comorbidities

NSQIP disclosure

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Fouad Chouairi

Fouad Chouairi, B.S.: Study Design, Data Collection, Statistical Analysis, Tables, Manuscript Preparation and Revisions

Elbert J. Mets

Elbert J Mets, B.A.: Study Design, Data Collection & Analysis, Manuscript Preparation and Revisions

Sina J. Torabi

Sina J Torabi, B.A.: Study Design, Tables, Manuscript Preparation and Revisions

Michael Alperovich

Michael Alperovich, M.D., M.Sc.: Principle Investigator, Study Design, Tables, Manuscript Preparation and Revisions.