Purpose Primary surgical repair of a cleft lip is usually followed by 23-hour hospital admission. A recent article has advocated outpatient cleft lip repair with same-day discharge as a safe alternative (J Plast and Recon. Surg. 2003 Aug;112(2):381–7). Further investigation is required regarding the potential risks during the first 24 hrs after surgery.
Study Design and Methods Four directly related studies on primary cleft lip repair were designed to identify the risks and benefits of same day discharge versus 23 hr-admission: 1) A retrospective chart review of the complication rate in the first 24 hrs following 200 consecutive cleft lip repairs at two major pediatric tertiary care centers (Children’s Hospital and Regional Medical Center (CHRMC), Seattle and Hospital for Sick Children, Toronto); 2) A national survey of cleft surgeons to determine opinions about discharge practices following cleft lip repair; 3) A post-operative questionnaire for parents to determine their opinions regarding same day discharge; 4) Analysis of complication rate related to length of stay using the PHIS national database of major pediatric centers.
Results 1) The CHRMC chart review found 2 of 109 infants (1.8%) experienced a life-threatening complication in the first 24 hrs post-op. The Hospital for Sick Children review is still being analyzed. 2) To date, 21% of eligible respondents completed the national physician’s survey (n=129). 75% of respondents reported discharging their patients home after 23 hr admission, while 17.8% performed same day surgery. 23% reported at least one patient that developed life-threatening complications in the first 24 hrs post-op. 3) We are waiting for all questionnaires to be collected before analysis can begin. 4) The PHIS national database proposal has been submitted to the Children’s Health Initiative (CHI) for funding.
Conclusion Our preliminary results indicate that up to 2% of infants experience complications in the first 24 hrs following cleft lip repair and up to 11% of surgeons recollect a complication in the first 24 hrs post-op that they felt would have had a worse outcome had the patient been discharged the same day as surgery. The current standard of practice following cleft lip surgery remains at least one night observation in hospital, with only 18% of respondents currently performing same day cleft lip surgery. Our data to date does not justify the practice of same day cleft lip repair, but we await the results of the remaining studies to examine this question further.
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