Outpatient Cleft Lip Repair

Abstract

The emphasis on cost reduction and increased efficiency in health care delivery has prompted an increase in outpatient (ambulatory) surgical procedures. A retrospective review of the perioperative management of patients undergoing cleft lip repair at two urban tertiary pediatric hospitals was performed to assess the safety of outpatient cleft lip repair. The hospital database at Childrens Hospital Los Angeles was searched to find all patients who had been operated on for cleft lip repair during calendar years 1999 and 2000. Two groups were identified from Childrens Hospital Los Angeles: the outpatient cleft lip repair group (patients discharged the same day as the operation; n = 91) and the inpatient cleft lip repair group (n = 14). A data set was acquired from the Royal Children's Hospital in Melbourne, Australia, using the same criteria, for fiscal years 1998 to 2000 (n = 50). All patients from Royal Children's Hospital had operations as inpatients. Parameters considered for each group were age, sex, race, ethnicity, length of hospital stay, preexisting medical conditions or diagnoses, complications, and readmissions or presentation to the emergency department within 4 weeks of operation. The Childrens Hospital Los Angeles outpatient group had three readmissions that were considered to be complications of the operation. The Childrens Hospital Los Angeles inpatient group had one readmission attributable to a complication. The Royal Children's Hospital group also had one readmission for a complication. There was no significant difference in the complication rate of the Childrens Hospital Los Angeles outpatient group and the Royal Children's Hospital group (p > 0.05). There was also no significant difference in the complication rate of both of the Childrens Hospital Los Angeles groups compared with the Royal Children's Hospital group (p > 0.05). This study indicates that cleft lip repair performed in an outpatient setting may be a safe alternative to the inpatient operation. Certain preexisting medical conditions, however, may dictate the need for inpatient hospitalization after repair.

Predictors of Readmission after Outpatient Plastic Surgery

“…The field of plastic and reconstructive surgery has been at the forefront in the use of outpatient procedures and has emphasized patient safety throughout this effort. 18,26,40 Although outpatient plastic surgery is seen as a safe field, there remain inherent risks with surgery that may predispose patients to an increased likelihood for readmission. Therefore, isolating preventable readmissions is a challenge.…”

Aspects épidémiologiques, cliniques et thérapeutiques des fentes unilatérales du palais primaire : présentation de 98 observations

“…Les progrès de l'anesthésie-réanimation et l'élévation du coût des soins de santé conduisent la plupart des équipes à réduire la durée d'hospitalisation. La tendance actuelle est à la chirurgie ambulatoire et elle ne semble pas présenter une morbidité supérieure à l'hospitalisation classique [14,15]. Aucun décès post-opératoire n'a été constaté pendant la pé-riode de l'étude.…”

Ambulatory cleft lip surgery: A value analysis

“…Integral to any changes in traditional practices of patient care is a careful scrutiny of outcomes from a quality and safety perspective. Due to a change in inpatient duration of hospital stay through the 1980s, a series of audits regarding the complication rates of short-stay were performed (7)(8)(9)(10)(11)(12)(13). These authors suggested no significant complications were found with shorter hospital stays.…”

“…A two-centre retrospective evaluation involving 155 patients treated with ambulatory compared with inpatient cleft lip repair was conducted by Rosen et al (8). Their results suggested no differences between ambulatory or inpatient cleft lip patients with respect to complication or readmission rates; they concluded that patients with preexisting medical conditions would benefit from admission to monitor for serious complications; however, readmission rates may not decrease with either inpatient or ambulatory surgery given the finding that readmissions were often occurring in a delayed fashion.…”

“…To be a candidate for ambulatory cleft lip repair, children must be able to be cared for in the same manner as an outpatient as they would be cared for in hospital (8). These children must meet specific discharge criteria including an uncomplicated recovery from anesthesia, wellcontrolled pain, the ability to tolerate an oral dietary intake in the early postoperative period, in additon to well-educated and motivated parents who are able to care for the child (9).…”