An Assessment of 30-Day Complications in Primary Cleft Lip Repair: A Review of the 2012 ACS NSQIP Pediatric

Abstract

Objective The aim of this study is to identify risk factors associated with complications and readmissions following cleft lip repair using the multicenter American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric. Design Patients undergoing CPT codes 40700, 40701, and 40702 were extracted from the ACS NSQIP Pediatric. Fisher exact, χ2, and rank-sum tests were used to evaluate risk factors. Results Of the 525 patients included, 4.2% had complications, with respiratory complications being the most common. Risk factors included congenital malformations ( P = .001), ventilator dependence ( P = .002), oxygen support ( P = .016), tracheostomy ( P = .005), esophageal/gastric/intestinal disease ( P = .007), impaired cognitive status ( P = .034), acquired central nervous system abnormality ( P = .040), nutritional support ( P = .001), major and severe cardiac risk factors ( P = .011 and P = .005), and an American Society of Anesthesiologists score of 3 ( P = .002). In addition, complications were associated with undergoing a one-stage bilateral repair ( P = .045) or concomitant ear, nose, and throat procedure ( P = .045). The readmission rates for ambulatory patients and inpatients were 2.6% and 4.9% ( P = .556), with an overall readmission rate of 4.6%. Ambulatory patients were older ( P = .005) and had shorter operative times ( P < .001). Conclusions Perioperative complications are low following cleft lip repair, with respiratory complications being the most common. Readmission rates of 4.6% are higher than expected, and insight into predictors of complications will allow surgeons to identify patients who could benefit from additional resources.