Ten Years of Pediatric Velopharyngeal Insufficiency Surgery: National Operative Trends, 30-day Complication Rates, and Implications.

BackgroundVelopharyngeal insufficiency (VPI) can be effectively treated surgically with palatal lengthening or pharyngeal procedures. There is limited data on long-term national trends in their use and associated outcomes. This study evaluates 10 years of trends and outcomes in VPI-correcting procedures.MethodsWe conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database, identifying cases with CPT codes corresponding to VPI-correction procedures. Patients 6 to 18 years old were included. Outcomes included operative characteristics and postoperative complications.ResultsOf 5957 cases, 45% were palatal lengthening, and 55% were pharyngeal procedures (63% pharyngeal flap and 37% sphincter pharyngoplasties). Palatal procedures had longer operative (P < 0.001) and anesthesia (P < 0.001) durations compared to pharyngeal procedures. Pharyngeal flaps had longer operative (P < 0.001) and anesthesia (P < 0.001) durations compared to sphincter pharyngoplasties. Palatal-lengthening surgeries had higher rates of wound dehiscence (P = 0.001) but no significant difference in major complications compared to pharyngoplasties. No differences in complication rates between pharyngeal flaps and sphincter pharyngoplasties were observed.DiscussionLow complication rates across palatal lengthening and pharyngeal procedures suggest that VPI surgical planning should prioritize factors such as patient anatomy, existing comorbidities, and the potential risks associated with prolonged operative and anesthesia times.