Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

• Published in: The Cleft palate-craniofacial journal Vol. 58; no. 5; p. 603
• Main Authors: Vu, Giap H, Kalmar, Christopher L, Zimmerman, Carrie E, Humphries, Laura S, Swanson, Jordan W, Bartlett, Scott P, Taylor, Jesse A
• Format: Journal Article
• Language: English
• Published: United States 01.05.2021
• Subjects: Child; Cleft Lip; Cleft Palate - surgery; Fistula; Hospitals; Humans; Infant; Oral Fistula - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Treatment Outcome; cleft palate repair; oronasal fistula; hospital volume, cost-to-charge ratio
• ISSN: 1545-1569
• DOI: 10.1177/1055665620959528

This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics-cost-to-charge ratio (RCC) and case volume of cleft palate repair. Retrospective cohort study. This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], = .233; AOR = 0.86 [0.62-1.20], = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], = .005; AOR = 3.14 [1.80-5.58], < .001). Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.