Predicting the Ideal Patient for Ambulatory Cleft Lip Repair

Chang, Victor; O’Donnell, Brendan; Bruce, William J.; Maduekwe, Uma; Drescher, Max; Mendez, Bernardino M.; Kothari, Anai N.; Patel, Parit A.

doi:10.1177/1055665618779980

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…Reported values range from 17% to 68% of patients with a cleft receiving outpatient surgery, and these data are further varied depending on whether the term outpatient is used for single night stay or same-day discharge. 8,16 A recent survey of the US surgeons performing unilateral cleft repair reported 76% of surgeons reported average LOS of 23 h, with just 10% reporting UCL repair as an outpatient procedure. 17 An international survey on cleft lip repair showed LOS ranges from 1 to 14 days, highlighting the diversity of current practiced protocols.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…7 However, despite a national shift toward ambulatory surgery, centers that perform cleft lip repair vary in their surgery protocols, and the ambulatory versus inpatient decision is largely based on surgeon preference. 8 An important consideration in the decision to perform ambulatory cleft surgery is safety outcomes. Large database retrospective studies have identified patient factors to consider when deeming eligibility for outpatient cleft surgery, such as preexisting comorbidities, cardiac or airway problems, and patient age.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Park

Colon

Chaya

et al. 2022

The Cleft Palate Craniofacial Journal

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Objectives Cleft lip repair has traditionally been performed as an inpatient procedure. There has been an interest toward outpatient cleft lip repair to reduce healthcare costs and avoid unnecessary hospital stay. We report surgical outcomes following implementation of an ambulatory cleft lip repair protocol and hypothesize that an ambulatory repair results in comparable safety outcomes to inpatient repair. Design/Setting This is a single-institution, retrospective study. Patients/Participants Patients undergoing primary unilateral (UCL) and bilateral (BCL) cleft lip repair from 2012 to 2021 with a minimum 30-day follow-up. A total of 226 patients with UCL and 58 patients with BCL were included. Intervention Ambulatory surgery protocol in 2016. Outcome Measures Variables include demographics and surgical data including 30-day readmission, 30-day reoperation, and postoperative complications. Results There were no differences in rates of 30-day readmission, reoperation, wound complications, or postoperative complications between the pre- and post-protocol groups. Following ambulatory protocol implementation, 80% of the UCL group and 56% of the BCL group received ambulatory surgery. Average length of stay dropped from 24 h pre-protocol to 8 h post-protocol. The 20% of the UCL group and 44% of the BCL group chosen for overnight stay had a significantly higher proportion of congenital abnormalities and higher American Society of Anesthesiology (ASA) class. Reasons for overnight stay included cardiac/airway monitoring, prematurity, and monitoring of comorbidities. There were no differences in surgical outcomes between the ambulatory and overnight stay groups. Conclusions An ambulatory cleft lip repair protocol can significantly reduce average length of stay without adversely affecting surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Park

Colon

Chaya

et al. 2022

The Cleft Palate Craniofacial Journal

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“…For example, children with differing craniofacial syndromes, difficult airways, central nervous system diagnoses, and cardiac abnormalities have been shown to have more perioperative complications and readmission rates after CL/P repair. [31][32][33][34] With over fifty genetic transcription factors and signaling factors shown to be involved in CwHP, these additional comorbidities can include holoprosencephaly, septo-optic dysplasia, esophageal atresia, and neonatal hypoglycemia. 10,16 The results of the present study support that CwHP is another abnormality that needs specific and multispecialty care during their CL/P repair course to reduce their risk of perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

Cleft Lip and/or Palate Repair in Children With Hypopituitarism: Analysis of the Kids’ Inpatient Database

Poupore

Chidarala

Nguyen

et al. 2022

The Cleft Palate Craniofacial Journal

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Objective Children with hypopituitarism (CwHP) can present with orofacial clefting, frequently in the setting of multiple midline anomalies. Hypopituitarism (HP) can complicate medical and surgical care; the perioperative risk in CwHP during the traditionally lower risk cleft lip and/or palate (CL/P) repair is not well described. The objective of this study is to examine the differences in complications and mortality of CL/P repair in CwHP compared to children without hypopituitarism (CwoHP). Design A retrospective cross-sectional analysis. Setting The 1997 to 2019 Kids’ Inpatient Databases (KID). Patients Children 3 years old and younger who underwent CL/P repair. Main Outcome Measure(s) Complications and mortality. Results A total of 34 106 weighted cases were analyzed, with 86 having HP. CwHP had a longer length of stay (3.0 days [IQR 2.0-10.0] vs 1.0 day [IQR 1.0-2.0], P < .001) and higher rates of complications and mortality (12.8% vs 2.9%, P < .001) compared to CwoHP. Controlling for demographic factors, CwHP had 6.61 higher odds of complications and mortality than CwoHP (95% CI 3.38-12.94, P < .001). Conclusions CwHP can present with a CL/P and other midline defects that can increase the complexity of their care. These data show a significant increase in length of stay, complications, and mortality in CwHP undergoing CL/P repair. Increased multidisciplinary attention and monitoring may be needed for these children peri- and postoperatively, especially if additional comorbidities are present. Further studies on perioperative management in this population are warranted to reduce morbidity and mortality.

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“…In addition, Chang V et al used uplift modeling to predict the patient appropriate for ambulatory cleft repair. The uplift modeling is a predictive analytics technique, which was utilized using multivariate logistic regressions [26].. Kartoun U et al developed an insomnia classification algorithm to identify insomnia patients, and the algorithm had better performance compared with traditional methods [27].…”

Section: Data Mining In Healthcare and Biomedicinementioning

confidence: 99%

Application of data mining for predicting hemodynamics instability during pheochromocytoma surgery

Zhao

Cui

et al. 2020

BMC Med Inform Decis Mak

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Background: Surgical resection of pheochromocytoma may lead to high risk factors for intraoperative hemodynamic instability (IHD), which can be life-threatening. This study aimed to investigate the risk factors that could predict IHD during pheochromocytoma surgery by data mining. Method: Relief-F was used to select the most important features. The accuracies of seven data mining models (CART, C4.5, C5.0, and C5.0 boosted), random forest algorithm, Naive Bayes and logistic regression were compared, the cross-validation, hold-out, and bootstrap methods were used in the validation phase. The accuracy of these models was calculated independently by dividing the training and the test sets. Receiver-Operating Characteristic curves were used to obtain the area under curve (AUC). Result: Random forest had the highest AUC and accuracy values of 0.8636 and 0.8509, respectively. Then, we improved the random forest algorithm according to the classification of imbalanced data. Improved random forest model had the highest specificity and precision among all algorithms, including relatively higher sensitivity (recall) and the highest f1-score integrating recall and precision. The important attributes were body mass index, mean age, 24 h urine vanillylmandelic acid/upper normal limit value, tumor size and enhanced computed tomography difference. Conclusions: The improved random forest algorithm may be useful in predicting IHD risk factors in pheochromocytoma surgery. Data mining technologies are being increasingly applied in clinical and medical decision-making, and provide continually expanding support for the diagnosis, treatment, and prevention of various diseases.

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Predicting the Ideal Patient for Ambulatory Cleft Lip Repair

Abstract: Uplift modeling predicts that approximately 40% of patients would benefit from an ASC cleft lip repair. Targeting patients younger than 1 year old, nonsyndromic, with no respiratory or neurologic diagnosis for ASC cleft lip repair, may be a safe and cost-saving endeavor.

Cited by 7 publications

References 7 publications

Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Cleft Lip and/or Palate Repair in Children With Hypopituitarism: Analysis of the Kids’ Inpatient Database

Application of data mining for predicting hemodynamics instability during pheochromocytoma surgery

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