Study Shows Variation in Rates of Secondary Cleft Lip and Palate Surgery
For children with cleft lip and palate, the chances of undergoing secondary surgery vary depending on the center where they're treated, reports a study in Plastic and Reconstructive Surgery-Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).
When secondary surgeries are performed, they don't necessarily improve the child's final facial appearance, according to the new research by ASPS Member Surgeon Dr. Thomas J. Sitzman of Cincinnati Children's Hospital Medical Center and colleagues.
Secondary Cleft Lip and Palate Surgery—Variation and Outcomes
The researchers analyzed 130 children undergoing surgery to repair cleft lip and cleft palate at four specialized centers. The patients were part of the "Americleft" study, designed to compare surgical outcomes across North American cleft palate centers. All patients had cleft lip/cleft palate as their only abnormality, unrelated to any congenital syndrome.
Rates of secondary surgeries-additional procedures performed on the lip, palate, and/or nose after the initial (primary) surgery-were compared across the study centers. Patients were followed up through adolescence.
The results showed significant variation in rates of secondary lip surgery and secondary nasal surgery (rhinoplasty) at the four cleft palate centers. Through ten years, the estimated rate of secondary lip surgery by center ranged from five percent to 60 percent. There was also substantial variation in rates of secondary rhinoplasty-from 47 to 79 percent by age 20 years.
Overall, the risk of secondary lip surgery varied 12-fold across centers, while the risk of secondary rhinoplasty varied six-fold. There was no significant variation in secondary palate surgery.
Surgeon ratings of follow-up photographs found no significant difference in the final appearance of the nose and lip for patients who had secondary surgery versus primary surgery only. (The researchers emphasize that secondary surgery may have improved outcomes for some children, even though there was no overall difference between groups.)
Secondary surgery for cleft lip and palate adds to the "burden of care" in terms of pain and fear for children and time off work for parents, as well as higher healthcare costs. The results are consistent with a previous European study (Eurocleft) reporting variations in secondary surgery rates.
"This study raises the important question of why variation exists between centers in the use of secondary surgery," Dr. Sitzman and colleagues write. It may be that some centers achieve better results with the initial surgery, or that centers have different thresholds for recommending further surgery. The researchers note that their study didn't include photos to assess the results of the primary surgery.
But regardless of the source of the variation, "The effect is broad differences in a child's burden of surgical care depending upon where they are treated," Dr. Sitzman and coauthors write. They call for further studies to better define the role of secondary surgery for children with cleft lip and palate.
About PRS Global Open
Plastic and Reconstructive Surgery—Global Open (PRS Global Open) is an open access, rigorously peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS Global Open educates and supports plastic surgeons globally to provide the highest quality patient care and maintain professional and ethical standards through education, research, and advocacy.
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 8,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.
About Wolters Kluwer
Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.
Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).
Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.