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To Admit or Not to Admit: That is the Cleft Lip Question. Confirming the Safety of Outpatient Cleft Lip Repair

Fahradyan, Artur, M.D.; Galdyn, Izabela, M.D.; Azadgoli, Beina, M.S.; Tsuha, Michaela, B.S.; Urata, Mark M., M.D., D.D.S.; Francis, Stacey H., M.D.

Plastic and Reconstructive Surgery: July 2018 - Volume 142 - Issue 1 - p 159-168
doi: 10.1097/PRS.0000000000004473
Pediatric/Craniofacial: Original Articles
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Background: There is no accepted protocol for inpatient versus ambulatory cleft lip surgery. The aim of this study was to review the safety of outpatient repair and develop guidelines.

Methods: A retrospective review of patients younger than 2 years undergoing primary cleft lip repair from 2008 to 2015 at six centers was performed. Patients were divided into two groups: predominantly ambulatory (discharged or admitted for specific concerns) and inpatient (admitted due to surgeon’s preference). The impact of independent variables on admission, emergency department visits, and readmission within 1 month of discharge was analyzed.

Results: Of 546 patients, 68.1 percent were boys, 4.4 percent had syndromes, and 23.6 percent had comorbidities. One hundred forty-two patients were admitted postoperatively. Forty-nine admissions were attributable to the surgeon’s preference. After excluding this subset, our ambulatory surgery rate was 81 percent. There was no difference in emergency department visits (3 percent versus 2.2 percent; p = 0.6) or readmissions (0 percent versus 1.45 percent; p = 0.5) between groups. None of the ambulatory surgery patients were readmitted within 36 hours, for a successful ambulatory surgery rate of 100 percent. Female sex; surgical time; prematurity and/or postconceptional age younger than 52 weeks; and cardiac, respiratory, central nervous system, gastrointestinal, genitourinary, and other congenital comorbidities had significant impact on admission rates in the predominantly ambulatory group (p < 0.05). Respiratory comorbidities and syndromes were risk factors for readmission if patients presented to the emergency department (p < 0.05).

Conclusions: Ambulatory cleft lip repair can be performed safely in most patients with no difference in emergency department visits or readmission. Patients with comorbidities should be admitted for observation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

This and Related “classic” Articles Appear on Prsjournal.com for Journal Club Discussions.Patient Safety CME.

Los Angeles and Loma Linda, Calif.

From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles; the Division of Plastic and Reconstructive Surgery, University of Southern California; the Division of Plastic and Reconstructive Surgery, Loma Linda University Medical Center; the Keck School of Medicine of the University of Southern California; and the Division of Plastic and Reconstructive Surgery, Southern California Permanente Medical Group.

Received for publication August 11, 2017; accepted December 29, 2017.

Presented at the 74th Annual Meeting of the American Cleft Palate–Craniofacial Association, in Colorado Springs, Colorado, March 13 through 18, 2017.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form.

Stacey H. Francis, M.D., Craniofacial Services, Southern California Permanente Medical Group, 6041 Cadillac Avenue, Los Angeles, Calif. 90034, stacey.h.francis@kp.org

Copyright © 2018 by the American Society of Plastic Surgeons