The ambulatory care program reduced the hospital admission rate and reduced cost without jeopardizing the TWOC success rate and safety in the management of patients presenting with AUR.

Aim In the past, von Langenbeck palatoplasty was the technique adopted for cleft palate repair at our institution. Since 2002, Furlow palatoplasty has become the technique of choice. The present study aims to compare the outcome of cleft palate repair in children using the two different techniques. Patients and Methods All children who underwent primary cleft palate repair at our institution from January 1996 to December 2011 were studied. The sex, type of cleft palate, age at operation and the presence of associated syndromes were recorded. Postoperative outcome, including the incidence of oronasal fistula (ONF) and pharyngoplasty, were studied. Results A total of 230 children were included in this study. There were 120 boys and 110 girls. Ninety‐five children had cleft palate associated with cleft lip; 135 children had cleft palate only. Twenty‐eight children were syndromic. The mean age at operation was 19 ± 20 months (range: 10–150 months). A total of 112 children underwent von Langenbeck repair, and 118 children underwent Furlow repair. There was no statistical different in the sex, age at operation and associated syndromes between the two groups. More children had isolated cleft palate in the Furlow group (P < 0.05). Nineteen children developed ONF after surgery (Langenbeck : Furlow, 13:6; P = 0.072). Twenty one of 112 (19 per cent) children required pharyngoplasty to correct velopharyngeal insufficiency after von Langenbeck repair. No child in the Furlow group required pharyngoplasty (P < 0.05). Conclusions The frequency of ONF after palatoplasty was 11.6 per cent after von Langenbeck repair, and 5.1 per cent after Furlow's palatoplasty. Compared with von Langenbeck repair, Furlow palatoplasty appeared to have a superior outcome, with no child requiring pharyngoplasty.

Aim: Length of stay (LOS) is an important outcome measure of the Surgical Outcomes Monitoring and Improvement Program (SOMIP). After analyzing the outcomes of the first two SOMIP reports, we introduced the Palatoplasty Enhanced Recovery (PER) pathway for primary cleft palate repair in 2012. We aim to study if the implementation of PER pathway can decrease the LOS without increasing the complication rate. Methods: All children who underwent primary cleft palate repair from January 2008 to April 2015 were studied. PER pathway was introduced in January 2012. Demographics data, postoperative outcomes including the LOS, readmission, morbidity and oro-nasal fistula (ONF) were compared between patients operated before (pre-PER) and after (PER) the implementation of the pathway. Results: Eighty five children were recruited in the study (29 PER and 56 pre-PER). There were no statistical differences in the age, sex, type of cleft palate and associated syndrome between the two groups. Incidence of ONF (PER 13.8% vs pre-PER 8.9%, p = 0.490), morbidity (0% vs 5.4%, p = 0.204) and readmission (6.9% vs 3.6%, p = 0.493) were not statistically different. Median LOS (3 days vs 6 days, p < 0.0001) was significantly shorter in the PER group. Conclusions: The implementation of the PER pathway for primary cleft palate repair significantly decreased the length of stay without an increase in morbidity and readmission. The SOMIP initiated the establishment of the PER pathway and the positive outcome can be reflected in subsequent SOMIP reports.