Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Abstract

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.

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

“…Five studies compared the safety of inpatient and outpatient surgery (Supplemental Table 9, Supplemental Digital Content 9, http://links.lww.com/SCS/E646). Of these, 3 directly compared inpatient to ambulatory or outpatient cleft lip and palate surgery 55–57. Francis and Flores found there to be no difference in emergency department visits or readmissions between groups,55 whereas Kantar et al56 found a significantly higher risk of superficial and deep wound dehiscence ( P =0.01) in the outpatient group, but a lower risk of reoperation ( P =0.04) and readmission ( P =0.02).…”

“…[55][56][57] Francis and Flores found there to be no difference in emergency department visits or readmissions between groups, 55 whereas Kantar et al 56 found a significantly higher risk of superficial and deep wound dehiscence (P = 0.01) in the outpatient group, but a lower risk of reoperation (P = 0.04) and readmission (P = 0.02). Park et al 57 found no difference in rates of readmission, reoperation, or post-operative complications between patients treated using an ambulatory cleft lip surgery protocol or an inpatient procedure (minimum 1 night hospital stay). Wood et al 58 investigated the safety of a short stay (23 h) after primary cleft palate repair.…”

Advances in Cleft Lip and Palate Surgery

“…In a recent single-institution retrospective study, 226 patients with unilateral cleft lip and 58 patients with bilateral cleft lip were included, where 80% of the unilateral group and 56% of the bilateral group received ambulatory surgery with an average length of stay of 8 h, compared to 24 h preintervention. Patients requiring cardiac or airway monitoring, with history of prematurity and comorbidities, were chosen for overnight stay instead [30]. This study also showed the safety and feasibility of ambulatory cleft lip surgery, again, in the carefully selected patients.…”