Steroids Decrease Costs and Improve Hospital Stay in Cleft Palate and Speech Surgery Despite Controlling for Duration of Surgery

PURPOSE:

We previously showed postoperative steroids lead to shorter hospital stays and improved oral intake, without wound healing problems in patients undergoing cleft palate or secondary speech surgery.  In this new analysis, we controlled for duration of surgery and evaluated clinical as well as cost outcomes.

METHODS:

Cleft palate and secondary speech operations from 2010 to 2012 were reviewed.  Length of stay (LOS) was defined as discharge time minus procedure-end time.  The financial department provided cost data.  Steroids were measured as total dexamethasone equivalents per kilogram, classified as steroids (S) versus no steroids (NS).  Nonparametric tests were used to compare continuous outcomes (Mann-Whitney) and categorical outcomes (Fisher exact).

RESULTS:

After controlling for duration of surgery by eliminating NS patients with longer duration of surgery than the maximum S patient, 65 patients qualified for our study: S 16, NS 49.  Average age at surgery was 6.5 years, with average follow-up of 1.1 years. The average LOS were: S 23 hours, NS 33 hours, *P=0.005.

Hospital data revealed: poor oral intake: S 0% (0/15), NS 47% (23/49), ***P<0.001; average maximum pain score (range 1 to 10): S 3.25, NS 4.76, P=0.055; average total narcotics (morphine equivalents per kilogram) received on the floor: S 0.159, NS 0.158, P=0.951.

Postoperative clinic data disclosed: delayed wound healing: S 36% (5/14), NS 18% (9/49), P=0.272; operative site fistulas: S 14% (2/14), NS 10% (5/49), P=0.646; snoring: S 29% (4/14), NS 54% (26/48), P=0.131; sleep apnea: S 29% (4/14), NS 13% (6/48), P=0.213; and average Pittsburgh Weighted Speech Scores: S 6.5, NS 7.3, P=0.495.

Averages of both fixed and variable costs were: fixed S $2840, NS $3705, *P=0.013; variable S $3313, NS $3078, P=0.456. 

CONCLUSIONS:

Despite eliminating NS patients who had longer duration surgery that could potentially confound our previous study, our duration-matched groups still validated our previous hypotheses.  In cleft palate or secondary speech surgery, postoperative steroids lead to shorter hospital stays, improved oral intake, and lower fixed costs. There was no evidence for changes in delayed wound healing, fistula, snoring, sleep apnea, speech outcome, or variable costs.  This new analysis supports the benefits of postoperative steroids in both primary and secondary cleft palate speech surgery, for both patient and cost outcomes.