Implementation Of An Ambulatory Cleft Lip Repair Protocol
Jenn J. Park, BS, Ricardo Rodriguez Colon, BS, Bachar F. Chaya, MD, Danielle H. Rochlin, MD, Pradip R. Shetye, DDS, MDS, David A. Staffenberg, MD, Roberto L. Flores, MD.
NYU Langone Health, New York, NY, USA.
Purpose Cleft lip is the most common congenital condition affecting the face. Consistent with recent focus on reducing healthcare costs, there is growing interest in ambulatory cleft lip repair. Retrospective reviews have reported comparable outcomes between inpatient and outpatient cleft lip repair, but only based on pooled data without protocol-driven care. We report surgical outcomes following implementation of an ambulatory cleft lip repair protocol.
Methods We performed a single-institution retrospective study of patients undergoing primary unilateral cleft lip repair between 2012-2021 comparing surgical outcomes before and after protocol implementation in 2016. The ambulatory protocol selected non-syndromic patients without airway or cardiac abnormalities and involved morning surgery, long-lasting local anesthesia, and parental education with direct access to the clinical team. Variables included patient demographics, operative details, length of stay, and surgical outcomes including 30-day readmission and 30-day reoperation.
Results 261 patients met study criteria. The pre-protocol and post-protocol groups contained 99 and 162 patients, respectively, with no differences in rates of 30-day readmission, reoperation, or wound complications. Following protocol implementation, 130 (80%) patients underwent ambulatory surgery, and average length of stay decreased from 24 to 8 hours (p<0.05). The 32 patients staying overnight had higher rates of other congenital abnormalities (40.6%) than the ambulatory group (8.6%), with higher ASA class (p<0.05). Ambulatory and overnight stay patients had no differences in surgical outcomes.
Conclusions An ambulatory cleft lip repair protocol incorporating morning surgery, patient stratification, and parental education allows for safe ambulatory surgery, reducing length of stay without adversely affecting surgical outcomes.
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