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Hospital Volume Improves Primary, Revision, and Delayed Cleft Palate Repair

Wu, Robin T., BS*; Shultz, Blake N., BS*; Peck, Connor J., BS*; Smetona, John T., MD*,†; Steinbacher, Derek M., MD, DMD*,†

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1201–1205
doi: 10.1097/SCS.0000000000005270
Clinical Studies

Background: High volume centers (HVC) is commonly associated with increased resources and improved patient outcomes. This study assesses efficacy and outcomes of high volume centers in cleft palate repair.

Methods: Cleft palate procedures were identified in the Kids’ Inpatient Database from 2003-2009. Demographics, perioperative factors, co-morbidities, and complications in HVC (90th percentile, >48 cases/year) and non-high volume centers (NHVC) were compared across various cohorts of cleft repair.

Results: Four thousand five hundred sixty-three (61.7%) total cleft palate surgeries were performed in HVC and 3388 (38.3%) were performed in NHVC. The NHVC treated a higher percentage of Medicaid patients (P = 0.005) and patients from low-income quartiles (P = 0.018). HVC had larger bedsizes (P <0.001), were more often government/private owned (P <0.001), and were more often teaching hospitals (P <0.001) located predominantly in urban settings (P <0.001). The HVC treated patients at younger ages (P = 0.008) and performed more concurrent procedures (P = 0.047). The most common diagnosis at HVC was complete cleft palate with incomplete cleft lip, while the most common diagnosis at NHVC was incomplete cleft palate without lip. Overall, length of stay and specific complication rates were lower in HVC (P = 0.048, P = 0.042). Primaries at HVCs showed lower pneumonia (P = 0.009) and specific complication rates (P = 0.023). Revisions at HVC were associated with older patients, fewer cardiac complications (P = 0.040), less wound disruption (P = 0.050), but more hemorrhage (P = 0.040).

*Yale School of Medicine

The Section of Plastic and Reconstructive Surgery, Yale school of Medicine, CT.

Address correspondence and reprint requests to Derek M. Steinbacher, MD, DMD, Yale Plastic Surgery, 330 Cedar Street, Boardman Bldg—3rd Floor, New Haven, CT 06511, 203.785.2571; E-mail:

Received 2 June, 2018

Accepted 28 November, 2018

RTW and BNS contributed equally to this work.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.