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The Effect Of Preoperative Patient Characteristics On Postoperative Outcomes Of Cleft Palate Repair: An Analysis Of Global Smile Train Data
Emily S. Chwa, BA1, Jenna Stoehr, BA1, Arun K. Gosain, MD2.
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.

PURPOSE: The aim of this study was to identify patient characteristics that contribute to fistula and postoperative speech outcomes using global Smile Train data.
METHODS: Analysis of palatoplasty outcomes was performed for 1,110 Smile Train partner hospitals. Patient factors at palatoplasty, including age, weight, and region, were correlated with fistula occurrence and speech outcomes.
RESULTS: 2,560 patients were analyzed. The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 0.5 months and at speech assessment was 6.8 0.1 years. Underweight patients had higher incidence of hypernasality and worse speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of poor speech outcomes and fistula formation. Patients in Central/South America and Africa had worse speech outcomes and increased fistula occurrence and VPD surgery compared to patients in Asia. Patients in Central/South America were also more likely to require VPD assessment.
CONCLUSION: In the largest global cleft outcomes study to date, palatoplasty performed in underweight patients resulted in poor speech outcomes. Palatoplasty before age 6 months or after 18 months resulted in both poor speech outcomes and increased fistula formation. Region had a significant impact on outcomes. These results emphasize the importance of timely surgical intervention, adequate nutritional support, and access to consistent speech-language care to optimize international cleft care outcomes.

OR=odds ratio; *=p<0.05; OR comparisons to age 6-18 at surgery, Asia
FistulaHypernasalityHyponasalityNasal Air EmissionMild unintelligibilityModerate unintelligibilitySevere unintelligibilityRecommend further VPD assessmentVPD Surgery
Patient CharacteristicOR (p)OR (p)OR (p)OR (p)OR (p)OR (p)OR (p)OR (p)OR (p)
Underweight0.90 (0.55)1.58 (<0.01)*0.98
(0.97)
1.90 (<0.01)*1.22
(0.08)
1.73
(<0.01)*
1.52
(0.02)*
0.58
(0.02)*
1.33 (0.45)
1-5 months at surgery2.61 (0.02)*2.90
(0.03)*
6.23
(0.03)*
2.19 (0.01)*1.53
(0.18)
1.33
(0.46)
2.10
(0.16)
1.02
(0.98)
3.03 (0.14)
18 months - 3 years at surgery2.22 (<0.01)*1.60 (<0.01)*2.68
(0.01)*
3.09 (<0.01)*1.92
(<0.01)*
2.36
(<0.01)*
4.37
(<0.01)*
1.04
(0.16)
1.48 (0.38)
Over 3 years at surgery1.82 (<0.01)*5.14 (<0.01)*4.92 (<0.01)*5.97 (<0.01)*2.12
(<0.01)*
5.69
(<0.01)*
6.71
(<0.01)*
0.96
(0.86)
1.53 (0.37)
Africa4.13 (<0.01)*1.75
(0.17)
1.58
(0.67)
4.66 (<0.01)*2.04
(0.02)*
1.48
(0.25)
1.82
(0.22)
1.10
(0.87)
2.35 (0.25)*
Central/South America3.40 (<0.01)*0.92
(0.62)
1.20
(0.71)
4.00 (<0.01)*2.33
(<0.01)*
3.53
(<0.01)*
7.46
(<0.01)*
5.92 (<0.01)*3.00 (<0.01)*


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