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Does age affect outcomes in palatoplasty?
Edward H. Davidson MA (Cantab) MBBS, Darren M. Smith MD, Andrew L. Weinstein BA, Joseph E. Losee MD
University of Pittsburgh Plastic Surgery
2012-01-30
Presenter: Edward H Davidson
Affidavit:
Director Name: Joseph E Losee
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
1.This presentation addresses the current concept in cleft care of the affect of age at surgery on outcomes
2. This presentation outlines potential to forecast adverse outcomes in cleft care
3. This presentation provides new clinical data to guide management in reconstructive cleft surgery
How will your presentation be used by practicing physicians in the audience?
On the basis of this presentation physicians, in consenting families for cleft repair, may counsel that presenting at an older age does not seemingly increase risk for adverse outcomes in healing and speech development.
Furthermore,physicians can offer incidence rates of adverse outcomes depending on age and diagnosis
Background: Successful correction of velopharyngeal insufficiency in patients with cleft palate is essential for normal breathing, speech, and swallow. The Pittsburgh cleft protocol aims to perform a one-stage palatoplasty at age 9-12 months. Outcomes of patients undergoing palatoplasty are evaluated to establish whether those presenting at an older age are at greater risk of adverse outcomes.
Methods: A retrospective review was conducted of patients undergoing palatoplasty at Children's Hospital of Pittsburgh. Procedures were grouped by type (primary vs. secondary) and diagnosis (submucous cleft/Veau classification). Logistic regression analyses were used to identify correlation of age with Pittsburgh Weighted Speech Score, need for revision surgery, oronasal fistula rate and incidence of delayed healing. Furthermore, outcome measures were evaluated in stratified age categories to establish potential forecasts of outcomes
Results: 376 patients underwent palatal repair. Logistic regression analyses identified no overall correlation between age and any of the outcome measures. Considering primary palatoplasties separately showed a lower oronasal fistula rate in primary palatoplasty with older age (coefficient -0.044, p=0.024), a trend most pronounced with Veau III clefts (-0.64, p=0.009). For secondary palatoplasty, there was statistical evidence for a decrease need for revision speech surgery following secondary palatoplasty at an older age (-0.015, p=0.014), and for improved speech following secondary palatoplasty for Veau II clefts performed at an older age (-0.045, p=0.039).
Conclusions: Presenting at an older age for cleft palate repair does not increase risk for adverse outcomes. Furthermore, we can offer incidence rates of adverse outcomes depending on age and diagnosis.
