16.0: Thursday, March 17, 2005

Complications within the First 24 Hours Following Cleft Lip Repair: a Justification for Overnight Observation

Shahram Salemy, MD, Renee Umbenstock, BA, Charlotte Lewis, MD, Jacqueline Starr, BA, and Richard Hopper, MD.

Background: Potential risks during the first 24 hours after surgery and the advantages and disadvantages of same day discharge must be clarified before outpatient cleft lip repair is considered a standard of practice. Methods: 1) A review of the complication rate in the first 24 hrs following 200 consecutive repairs; 2) A survey of cleft surgeons on opinions about discharge practices; 3) A questionnaire administered to parents on opinions regarding discharge timing; and 4) Analysis of complication rates related to length of stay. Results: On chart review, two of 109 infants (1.8%) experienced a cardiopulmonary event in the first 24 hrs following surgery. 82% of physician's surveyed did not perform same day surgery. 23% recollected at least one patient that developed life-threatening complications in the first 24 hours post-op. Of those reporting complications, 49% believed the patients would have been worse off had they been discharged the same day as surgery. Conclusion: Our results suggest caution with the practice of same day cleft lip repair. Full analysis upon completion of these four studies will provide additional information on the risk of early complications following cleft repair, as well as the opinion of parents and surgeons regarding same day discharge.