Purpose: There are no multi-center studies/national estimates on how cardiac and pulmonary anomalies impact perioperative outcomes in patients with cleft palate (CP). The aim of this study is to further investigate the impact of congenital heart defects (CHD) and congenital pulmonary defects (CPD) on CP surgical outcomes on a national level.Methods: Patients who underwent surgical repair of CP between 2012-2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Main outcome measures included length of stay (LOS) and various perioperative complications.Results: 13,203 were determined to have CP, of whom 13.0% had CHD and 10.1% had CPD. Both CHD/CPD were significantly at greater risk of increased LOS and complications. Patients with CP and CHD had an average LOS of 1.6 days, 7.8% readmission rate, 9.1% reoperation rate, 0.8% reintubation rate, 1.4% wound dehiscence rate, 1.8% incidence of cerebrovascular accidents, and a mortality rate of 0.05% within 30 days of surgery. Patients with CP and CPD had an average LOS of 1.7 days, 7.2% readmission rate, 2.9% reoperation rate, 0.8% reintubation rate, 1.1% wound dehiscence rate, 2.7% incidence of cerebrovascular accidents, and a mortality rate of 0.06% within 30 days of surgery.Conclusion: This study demonstrates strong evidence that CHD/CPD is associated with increased adverse outcomes in the setting of CP repair. Thus, heightened clinical suspicion for coexisting congenital anomalies in the presence of CP should thus prompt referring providers to do a comprehensive and multidisciplinary evaluation to ensure cardiopulmonary optimization prior to surgical intervention.