BACKGROUND: This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims. METHODS: Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10-14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models. RESULTS: A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09-0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10-14 months (adjusted HR 0.40, 95%CI 0.31-0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57-0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty. CONCLUSIONS: In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.
BACKGROUND: This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims. METHODS: Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10-14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models. RESULTS: A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09-0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10-14 months (adjusted HR 0.40, 95%CI 0.31-0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57-0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty. CONCLUSIONS: In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.
Authors: Kamlesh B Patel; Stephen R Sullivan; Ananth S Murthy; Eileen Marrinan; John B Mulliken Journal: Plast Reconstr Surg Date: 2012-10 Impact factor: 4.730
Authors: Dennis C Nguyen; Kamlesh B Patel; Gary B Skolnick; Rachel Skladman; Lynn M Grames; Mary B Stahl; Jeffrey L Marsh; Albert S Woo Journal: Plast Reconstr Surg Date: 2015-07 Impact factor: 4.730
Authors: Sheree L Boulet; Scott D Grosse; Margaret A Honein; Adolfo Correa-Villaseñor Journal: Public Health Rep Date: 2009 May-Jun Impact factor: 2.792
Authors: Patricio Andrades; Antonio Espinosa-de-Los-Monteros; Dan H Shell; Todd E Thurston; Jessica S Fowler; Sudeep T Xavier; Peter D Ray; John H Grant Journal: Plast Reconstr Surg Date: 2008-10 Impact factor: 4.730
Authors: Carrie Stransky; Marten Basta; Cynthia Solot; Marilyn Cohen; David W Low; Don Larossa; Oksana Jackson Journal: Ann Plast Surg Date: 2013-09 Impact factor: 1.539
Authors: Adriane L Baylis; Gregory D Pearson; Courtney Hall; Lauren L Madhoun; Caitlin Cummings; Nancy Neal; Amanda Smith; Katherine Eastman; Christina Stocker; Richard E Kirschner Journal: Cleft Palate Craniofac J Date: 2018-03-28