Study Predicts Ideal Cleft Lip Patients for Procedures in Ambulatory Surgical Centers

Alyssa KirkmanJournal

Contact: Alyssa Kirkman
(919) 933-9044
alyssa.kirkman@acpa-cpf.org

CHAPEL HILL, N.C. / March 14, 2019 – Approximately 40 percent of patients would benefit from having their cleft lip repair surgery in an ambulatory surgical center (ASC), instead of a traditional hospital setting, according to research published in the February 2019 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“The shift toward using ASCs for cleft lip repair surgery is being driven by a growing interest to reduce medical costs,” said Victor Chang, lead researcher. “However, we must use caution to select the most appropriate patients for the ASC setting. Due to the numerous postoperative complications that may develop from the procedure, patients should be screened for certain pre-existing medical conditions to help ensure the best possible outcome.”

The study, Predicting the Ideal Patient for Ambulatory Cleft Lip Repair, used uplift modeling to demonstrate which patients can be ideally treated in an ASC. Research focused on 2,881 patients under the age of 18 who underwent a cleft repair in California between 2007 to 2011—the largest study of this type ever conducted. Of the 2,881 repairs, 2,383 (83%) were performed in an inpatient facility and 498 (17%) were conducted in an ASC.

Compared to the inpatient cohort, patients undergoing a procedure at an ASC were more likely to be black or Hispanic, less likely to have a diagnosis of failure to thrive, less likely to be syndromic, more likely to have a lower number of procedures, and more likely to be a simple cleft lip repair rather than a combined cleft lip and palate repair. Therefore, researchers concluded that surgeons in California currently select patients for ASC cleft repairs based on patient demographics, absence of certain diagnoses such as failure to thrive or a syndrome, the total number of procedures, and the type of procedure.

“Despite comparable outcomes to inpatient cleft lip repairs, only 17% of cleft repairs are being performed in an ASC. This study’s findings suggest that at least 40% of cleft lip repairs could be done in an ASC setting. By using uplift modeling predictions, we can offer ACS as a safe, cost-saving option to younger, nonsyndromic patients with no respiratory or neurologic diagnosis,” Chang said.

According to Jack C. Yu, DMD, MD, MS ED, Editor of CPCJ, where a surgeon chooses to perform lip repair surgery has been, and should continue to be, a medical decision made with the best interest of the patient in mind.

“In recent years, with progressive tightening of available funds and ever more stringent scrutiny of resource utilization, surgical decision making has become subject of intense study. Many are advocating evidence-based, protocol-driven, bundles and pathways to improve care while reducing costs. This article is an early example of such, adapting a simple mathematical model to predict which patients will be candidates for outpatient lip repair. The predictions have yet to be verified,” Yu states. “As we continue this trend, artificial intelligence and neural networks will iteratively elevate our decision-making abilities. It is critically important that we keep patient safety and surgical quality as the primary driver as these software packages are developed.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit acpa-cpf.org.

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit acpa-cpf.org.