American Association of Plastic Surgeons Meeting 2022

Implementation of an Ambulatory Cleft Lip Repair Protocol: Surgical Outcomes

Jenn Park1, Ricardo Rodriguez Colon1, Bachar F. Chaya1, Danielle H. Rochlin1, David A. Staffenberg1, Pradip R. Shetye1, Roberto L. Flores1

1Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health

•In patients with isolated unilateral cleft lip, the median health care cost in the first year of life is $13,013, 85% of which are comprised of surgical expenses.1,2

•Cleft lip repair has traditionally been performed as an inpatient procedure Studies suggest that ambulatory cleft lip surgery has the potential to reduce hospital-associated costs by more than 10%, which would lead to average savings of $4,261 per patient and national savings of $8,765,183 per year.3

•The purpose of this study is to investigate the effect of an ambulatory surgery protocol on surgical outcomes for primary unilateral and bilateral cleft surgery over a nine-year period.

•Single-institution, retrospective review

•patients undergoing primary unilateral or bilateral cleft lip repair from 2012-2021

•Implementation of ambulatory protocol in 2016

•Exclusion criteria: revision surgery, follow up < 30 days, records unavailable

•All patients underwent primary cleft lip repair with primary rhinoplasty and gingivoperiosteoplasty if indicated

•Demographics and surgical outcomes data were collected

•Chi-squared test/Fisher’s exact test and Mann-Whitney U test

Discussion

•No difference in safety outcomes following protocol for ambulatory surgery

•Protocol-based patient stratification leads to the majority of patients receiving ambulatory surgery

•Length of stay is significantly decreased

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Limitations

•Factors influencing eligibility of patients and cleft centers for ambulatory care cannot all be controlled

•Perioperative decision for overnight stay is a fluid combination of surgeon comfort, anesthesiologist input, and presence of comorbidities

•Unable to fully quantify burden of care shifted to family with ambulatory surgery

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Future Directions

•Explore patient/family-reported outcomes with ambulatory surgery

•Assess resources necessary to provide sufficient pre-, peri-, and post-operative counseling for ambulatory surgery

•Quantify healthcare savings achieved with an ambulatory surgery protocol

Jenn J. Park, BS

NYU Grossman School of Medicine

550 1st Ave New York, NY 10016

Jenn.Park@nyulangone.org

American Association of Plastic Surgeons Meeting 2022

Implementation Of An Ambulatory Cleft Lip Repair Protocol

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