Purpose statement: Sphincter pharyngoplasty is a widely used surgical procedure for the management of velopharyngeal insufficiency. Speech outcomes in relation to age at the time of operation have been extensively studied, however, there is minimal data on the relationship between immediate postoperative complications and the patients' age. Our objective in this study is to assess immediate postoperative complications among various age groups in patients who had undergone sphincter pharyngoplasty for velopharyngeal insufficiency.
Our hypothesis is that patients less than 6 years of age have a higher rate of perioperative complications.
Methods and Materials: This study is a retrospective chart review of 200 patients who underwent sphincter pharyngoplasty for velopharyngeal insufficiency at the authors' institution between the years 2000 and 2006. Approximately half of our patients are less than 6 years old. The minimal follow up period is one year. Variables evaluated were gender, age at time of surgery, medical history, length of ICU stay, and length of hospital stay. Complications analyzed were bleeding, respiratory distress, poor oral intake, wound complications, and frequency of revisional surgeries.
Results: Our preliminary results show that children less than 6 years of age are at greater risk for respiratory distress, poor oral intake, and additional revisional surgeries than children 6 years and older. As a result of these immediate complications, these patients required a longer hospital stay for closer monitoring and hydration.
Conclusion: Sphincter pharyngoplasty remains an effective surgical option for treating children with velopharyngeal insufficiency. The speech outcomes and rate of revisions of this operation have been extensively studied and published in the past, however, there is a paucity of data in regards to perioperative complications. In general, patients who undergo pharyngoplasty have a very brief and uneventful postoperative hospital course. Our preliminary results, however, indicate that patients younger than 6 years of age tend to have a more eventful postoperative course with a slightly higher rate of bleeding, respiratory compromise, and inadequate oral intake in the immediate postoperative period. We have also noted a higher frequency of revisional surgeries amongst this age group. The statistical significance of these results will be determined in the next several weeks as we finalize our data. If a statistical significance does exist, then perhaps pharyngoplasty should be postponed until after the age of 6 given the higher morbidity associated with this operation at a younger age.