Thresholds for Safety of Cleft Lip Surgery in Premature Infants

Christopher L. Kalmar, M.D., M.B.A.; Vijay A. Patel, M.D.; Laura S. Humphries, M.D.; Giap H. Vu, B.A.; Carrie E. Zimmerman, B.S.; Jordan W. Swanson, M.D.; Jesse A. Taylor, M.D.

Disclosures

Plast Reconstr Surg. 2020;146(4):859-862. 

In This Article

Abstract and Introduction

Abstract

Summary:The purpose of this study was to delineate optimal age to perform unilateral or bilateral cleft lip repair in premature patients. The American College of Surgeons National Surgical Quality Improvement Program Pediatric data set was queried for unilateral and bilateral cleft lip repairs performed between 2012 and 2017. Complications, readmissions, and reoperations were analyzed in the context of prematurity with appropriate statistics. Degree of prematurity was significantly associated with adverse events (p = 0.001, r s = 0.44). Premature patients with unilateral cleft lip had a significantly decreased risk of adverse events when performing cleft lip repair after 150 days of age [OR, 18.1; p = 0.004; before cutoff, n = 10 of 140 (7.1 percent); after cutoff, n = 0 of 112 (0.0 percent)] in the absence of other risk factors. Premature patients with bilateral cleft lip had a significantly decreased risk of adverse events when performing cleft lip repair after 175 days of age (OR, 16.1; p = 0.010; before cutoff, n = 7 of 33 (21.2 percent); after cutoff, n = 0 of 28 (0.0 percent)] in the absence of other risk factors.

Clinical Question/Level of Evidence: Risk, II.

Introduction

Repair of cleft lip facilitates feeding and appropriate nutrition,[1] and cleft surgeons often face parental pressure to repair cleft lip early. However, anesthesia during early infancy is associated with greater risk,[2,3] and there is some evidence that premature infants may have additional risk with anesthesia early in life.[4] The purpose of this study was to investigate safe timing of cleft lip repair in premature patients by establishing age thresholds at which unilateral and bilateral cleft lip may be repaired with the lowest risk of an adverse event.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....