Abstract: Cleft Palate Surgery: Factors Impacting Quality & Patient Safety (Plastic Surgery 2012)

Saturday, October 27, 2012: 3:00 PM

Christine Nguyen, BSc , Stanford University School of Medicine, Stanford, CA

Tina Hernandez-Boussard, PhD, MPH , Surgery, Stanford University School of Medicine, Palo Alto, CA

Sheryl M Davies, MA , Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA

Jay Bhattacharya, MD, PhD , Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA

Rohit K Khosla, MD , Surgery/Division of Plastic Surgery, Stanford University School of Medicine, Palo Alto, CA

Catherine M Curtin, MD , Surgery/Division of Plastic Surgery, Stanford University School of Medicine, Palo Alto, CA

Purpose: Cleft palate repair is a widely performed pediatric surgery yet rates of common peri-operative morbidities remain unclear. This study examines a national sample of patients to assess peri-operative outcomes for cleft palate repair as well as hospital factors impacting quality and patient safety. Specifically, this study evaluates whether pediatric hospitals use fewer resources and potentially provide better quality care.

Methods: Data were obtained from the Kids Inpatient Database from 1997, 2000, 2003, and 2006. Cohort was identified using the ICD-9-CM procedure code for cleft palate surgery (27.62). We examined patient age, race, sex, insurer, and comorbidities. Hospitals types included Pediatric Hospitals, General Hospitals, and Non-accredited Children’s Hospital (NAPH). Quality measures were mean length of stay (LOS), extended mean LOS (LOS>2), and complications. Quality measures were assessed by age groups <9 months, 9-12months, >12months.

Results: 14,153 patients had cleft palate repair with mean LOS of 2 days (SD 0.04), mortality rate of 0.01%, and transfusion rate of 0.3%. Less than 3% of children experienced a complication during their hospital stay. Mean total charges for cleft palate repair was $13,728 and increased to $24,087 with LOS>2 days; mean total costs was $5,419 overall, but increased to $9,465 with LOS>2 days. Complication rates did not vary with age but quadrupled in those with LOS>2 days. Comorbidities increased odds of LOS>2 by 2.7 times; comorbidities were highest in Pediatric Hospitals yet those cared for in non-pediatric hospitals had 4.3 times higher odds of LOS>2.

Conclusion: Cleft palate surgery has low mortality and acute complications. Pediatric Hospitals had higher comorbidities yet shorter LOS and fewer patients with LOS>2 than General Hospitals and NAPH. Total charges and costs nearly doubled with LOS>2. Additional research is needed to understand pediatric hospital resources associated with lower LOS, and thereby lower costs.

20466 Cleft Palate Surgery: Factors Impacting Quality & Patient Safety