Unplanned Intensive Care Unit Admission Following Cleft Palate Repair by Head and Neck Surgeons

Abstract

Objective To examine the incidence of pediatric intensive care unit (PICU) admission following primary repair of cleft palate by otolaryngologist–head and neck surgeons at 2 tertiary centers. To identify potential diagnoses associated with admission or unanticipated PICU transfer. Study Design Multi-institutional case series with chart review. Setting Two tertiary pediatric medical centers. Methods Children who underwent primary repair of cleft palate at 2 cleft centers over a 10-year period were identified. Charts were reviewed for demographics, comorbidities, and whether PICU admission was required. Results From 2009 to 2019, 464 patients underwent primary repair of a cleft palate by 1 of 6 otolaryngologist–head and neck surgeons with subspecialty training in cleft surgery; 459 patients had sufficient postoperative documentation and 443 children met inclusion criteria. The incidence of PICU admission was 9.3% (41/443), with 33 (7.4%) planned admissions and 8 (1.8%) unexpected PICU transfers. Syndromic conditions were associated with both planned and unanticipated PICU admissions. Conclusion The incidence of unanticipated postoperative PICU admission following cleft palate repair by otolaryngologist–head and neck surgeons was low. Risk stratification by surgeons with expertise in airway management may inform decisions regarding postoperative disposition of patients with medical or airway complexity who are undergoing cleft palate repair. Level of Evidence 4

National Trends of Otolaryngology Involvement in Cleft Surgical Management over 10‐Years

“…Additionally, a recent study of a cohort of 433 patients with significant syndromic and non-syndromic comorbidities treated by otolaryngology have shown that planning and unplanned Pediatric Intensive Care Unit admissions were low (approximately 7.0%). 21 Notably, PICU admission rates within this study were similar to previously described studies that had a smaller comorbidity burden. The most benign possibility is some form of reporting bias, as the NSQIP-P does not represent all institutions in the United States and therefore could represent facilities with higher complication rates compared with those that are unrepresented.…”

“…Another possibility includes treating more complex children with higher rates of comorbidities that make them prone to poor wound healing and subsequently more complications; this seems unlikely though, as our study demonstrated that otolaryngology performs more cleft repairs on these high‐risk patients, but do not have a higher rate of complication. Additionally, a recent study of a cohort of 433 patients with significant syndromic and non‐syndromic comorbidities treated by otolaryngology have shown that planning and unplanned Pediatric Intensive Care Unit admissions were low (approximately 7.0%) 21 . Notably, PICU admission rates within this study were similar to previously described studies that had a smaller comorbidity burden.…”