A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data.

IF 1.2 4区医学 Q3 DENTISTRY, ORAL SURGERY & MEDICINE

Cleft Palate-Craniofacial Journal Pub Date : 2024-12-01 Epub Date: 2023-07-27 DOI:10.1177/10556656231190517

Jessica L Marquez, Ashraf A Patel, Kaylee B Scott, Jack D Sudduth, Devin Eddington, Erinn Kim, Dana Johns, Alvin C Kwok, Jayant P Agarwal

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引用次数: 0

Abstract

Objective: We sought to identify differences in 30-day medical and surgical complications in unilateral versus bilateral palatoplasty.

Design: The NSQIP-P 2015-2020 database was queried to identify cleft palate repairs using CPT codes. Cases were stratified as unilateral (Veau III) and bilateral (Veau IV) using ICD-9 and -10 codes.

Setting: A nationally representative random sample.

Patients/participants: A total of 3791 cases were identified with 2608 undergoing unilateral repair and 1183 undergoing bilateral repair.

Main outcomes/measures: The postoperative outcomes of interest included surgical complications (surgical site infections, wound dehiscence), medical complications (pneumonia, urinary tract infection, seizure, cardiac arrest, bleeding/transfusions, systemic sepsis, unplanned intubation), readmission, and reoperation.

Results: The bilateral cohort was older (696 days versus 619 days, P < .001) and had longer operative times (157.3 min versus 144.5 min, P < .001). The unilateral cohort had more comorbidities including developmental delay, structural CNS abnormalities, need for nutritional support, and bleeding disorders. The bilateral cohort had statistically significant higher occurrences of wound dehiscence (2.1% versus. 1.2%, P = .03) and readmission (3.2% versus 1.7%, P = .01). On multivariate analysis, bilateral cleft repair (OR: 1.83, CI: 1.176-2.840, P = .007) and ASA class 4 (OR: 13.1, CI 2.288- 62.586, P = .002) were associated with greater odds of readmission.

Conclusion: Patients who underwent bilateral cleft repair had a higher proportion of 30-day postoperative complications and a two-fold increased odds of readmission. While palatoplasty is generally regarded as a safe procedure in the pediatric population, identifying factors related to an increased risk of early postoperative complications can help surgical teams better manage high-risk individuals.

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单侧和双侧腭成形术的术后效果比较：2015-2020年儿科NSQIP数据分析。

目的我们试图确定单侧与双侧腭成形术 30 天医疗和手术并发症的差异：设计：查询 NSQIP-P 2015-2020 数据库，使用 CPT 代码确定腭裂修复术。使用 ICD-9 和 -10 编码将病例分为单侧（Veau III）和双侧（Veau IV）：具有全国代表性的随机抽样：共有 3791 例患者，其中 2608 例接受了单侧修复术，1183 例接受了双侧修复术：术后相关结果包括手术并发症（手术部位感染、伤口裂开）、内科并发症（肺炎、尿路感染、癫痫发作、心脏骤停、出血/输血、全身脓毒症、意外插管）、再入院和再次手术：结果：双侧患者年龄更大（696 天对 619 天，P = .03），再入院率更高（3.2% 对 1.7%，P = .01）。在多变量分析中，双侧裂隙修复（OR：1.83，CI：1.176-2.840，P = .007）和ASA 4级（OR：13.1，CI：2.288- 62.586，P = .002）与再入院的几率更大相关：结论：接受双侧唇裂修复术的患者术后 30 天并发症的比例较高，再次入院的几率增加了两倍。虽然腭裂成形术在儿科人群中被普遍认为是一种安全的手术，但识别与术后早期并发症风险增加有关的因素有助于手术团队更好地管理高风险人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cleft Palate-Craniofacial Journal 医学-外科

CiteScore

2.70

自引率

36.40%

发文量

215

期刊介绍： The Cleft Palate-Craniofacial Journal (CPCJ) is the premiere peer-reviewed, interdisciplinary, international journal dedicated to current research on etiology, prevention, diagnosis, and treatment in all areas pertaining to craniofacial anomalies. CPCJ reports on basic science and clinical research aimed at better elucidating the pathogenesis, pathology, and optimal methods of treatment of cleft and craniofacial anomalies. The journal strives to foster communication and cooperation among professionals from all specialties.