Plastic Surgery Research Council

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Risk Factors for Airway-Related Complications Following Primary Palatoplasty: An Analysis of 3,616 Cases
Jordan T. Blough, BS, Chad A. Purnell, MD, Ian Chow, MD, Arun K. Gosain, MD.
Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

Purpose:
The present study examined risk factors associated with 30-day palatoplasty complications based on multivariate analysis of the NSQIP dataset.
Methods:
Primary palatoplasties were identified in the 2012-2015 Pediatric NSQIP database. Cases were analyzed with multivariate regression to investigate predictors for oronasal fistula/infection, airway complications (unplanned intubation or ventilation), length of stay (LOS) >3 days, and readmission. A sensitivity analysis was performed to determine whether increased operative time portends increased airway complications.
Results:
3,616 patients were included. Mean age at operation was 12.2 3.8 months and mean operative time was 135.4 67.5 minutes. Thirty-day complication rate was 7.6% overall, including 3.4% oronasal fistula/infection, 2.0% airway complication, 2.4% readmission, and 0.9% reoperation. 5.1% of patients had a LOS >3 days. Oronasal fistula/infection were not predicted by comorbidities, demographics or operative time. ASA class ≥3 (OR=3.04, p=0.022) and nutritional support (OR=3.19, p=0.024) predicted airway complications; sensitivity analysis also revealed operative duration >135 minutes was predictive (OR=2.79, p=0.009), increasing further when >225 minutes (OR=5.071, p=0.001). LOS >3 days was predicted by experiencing airway complications (OR=17.37, p<0.01), but preoperative ventilator dependence was protective (OR=0.08, p=0.008). Mean LOS was 1.6 1.8 days without an airway complication versus 5.0 4.3 with. Readmissions were increased for patients with nutritional support (OR=3.14, p=0.010), but decreased with premature birth (OR=0.248, p=0.012).
Conclusions:
This report represents the largest nationwide cohort of palatoplasty patients analyzed to-date. Analysis of these multi-institutional data demonstrate that airway complications with palatoplasty are increased with higher ASA class, requirement of nutritional support, and increasing operative time.


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