Wound Complications, Additional Ventilation Requirement, Prolonged Stay, and Readmission in Primary Palatoplasty: A Risk Factor Analysis of 3616 Patients

Background: The present study examined risk factors associated with 30-day palatoplasty complications based on analysis of national data. Methods: Primary palatoplasties were identified in the 2012 to 2015 Pediatric National Surgical Quality Improvement Program database. Cases were analyzed with multivariate regression to investigate predictors for wound healing complications, additional ventilation requirement, prolonged stay (>3 days), and readmission. Results: In 3616 operations, mean age was 12.2 months and operative time was 135.4 minutes. The 30-day complication rate was 7.6 percent overall, including wound dehiscence/infection (3.4 percent), additional ventilation requirement (2.0 percent), and readmission (2.4 percent); 5.1 percent of patients required prolonged stays. Wound healing complications were not predicted by comorbidities. American Society of Anesthesiologists class 3 or greater (OR, 2.8; p = 0.033), neuromuscular disorder (OR, 3.5; p = 0.029), and nutritional support (OR, 2.9; p = 0.035) predicted additional ventilation requirement. Prolonged stays were predicted by requiring additional ventilation (OR, 14.7; p < 0.001) or American Society of Anesthesiologists class 3 or greater (OR, 1.8; p = 0.047), but preoperative ventilator dependence was protective (OR, 0.1; p = 0.012). Mean hospital stay was 1.6 days without an airway complication versus 5.0 days with. Readmissions were increased for patients requiring nutritional support (OR, 2.6; p = 0.025). Conclusions: This study represents one of the largest cohorts of palatoplasty patients analyzed to date. It identifies what can be learned from a nonspecific 30-day registry regarding cleft outcomes and, from its limitations, discusses what the future of cleft outcomes research might entail. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.