Thomas J Sitzman1,2, Adam C Carle3,4, Jaclyn N Lundberg5, Pamela C Heaton6, Michael A Helmrath7, Carroll-Ann Trotman8, Maria T Britto3. 1. Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA. 2. Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ, USA. 3. Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 4. Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA. 5. Creighton University School of Medicine, Phoenix, AZ, USA. 6. James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA. 7. Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 8. Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA.
Abstract
OBJECTIVE: To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. DESIGN: Retrospective cohort study. SETTING: Forty-nine pediatric hospitals. PARTICIPANTS: Children who underwent cleft lip repair between 1999 and 2015. MAIN OUTCOME MEASURE: Time from primary cleft lip repair to secondary lip surgery. RESULTS: By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. CONCLUSIONS: There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.
OBJECTIVE: To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. DESIGN: Retrospective cohort study. SETTING: Forty-nine pediatric hospitals. PARTICIPANTS: Children who underwent cleft lip repair between 1999 and 2015. MAIN OUTCOME MEASURE: Time from primary cleft lip repair to secondary lip surgery. RESULTS: By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. CONCLUSIONS: There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.
Entities:
Keywords:
cleft lip; health services; secondary surgery
Authors: John Daskalogiannakis; Ana Mercado; Kathleen Russell; Ronald Hathaway; Gregory Dugas; Ross E Long; Marilyn Cohen; Gunvor Semb; William Shaw Journal: Cleft Palate Craniofac J Date: 2011-01-10
Authors: G Swennen; J L Berten; H Schliephake; C Treutlein; R Dempf; C Malevez; Mey A De Journal: Int J Oral Maxillofac Surg Date: 2002-02 Impact factor: 2.789
Authors: Thomas J Sitzman; Constance A Mara; Ross E Long; John Daskalogiannakis; Kathleen A Russell; Ana M Mercado; Ronald R Hathaway; Adam C Carle; Gunvor Semb; William C Shaw Journal: Plast Reconstr Surg Glob Open Date: 2015-08-10