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Cleft Palate Repair by Otolaryngologist‐Head and Neck Surgeons: Risk Factors for Postoperative Fistula
Author(s) -
Leu Grace R.,
Ebert Bridget E.,
Roby Brianne B.,
Scott Andrew R.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29191
Subject(s) - medicine , otorhinolaryngology , fistula , logistic regression , incidence (geometry) , craniofacial , surgery , retrospective cohort study , head and neck surgery , dentistry , physics , psychiatry , optics
Objectives/Hypothesis To assess the incidence of palatal fistula after primary repair of the cleft palate among two cohorts of Otolaryngologist‐Head and Neck Surgeons and to identify patient and surgeon characteristics that may predict fistula development. Study Design Retrospective case series with chart review. Methods Children who underwent primary repair of cleft palate at one of two multidisciplinary cleft centers over a 10 year period were identified. Charts were reviewed for the presence of palatal fistula; chi square test and multivariate logistic regression analysis were performed to determine variables associated with fistula formation. Results From 2007 to 2017, 477 patients underwent primary repair of cleft palate by one of 6 Otolaryngologist‐Head and Neck Surgeons. Twenty‐four children had incomplete charts, allowing 453 patients to be included in the final analysis. The pooled mean incidence of palatal fistula was 6.6% ( P = .525) and varied significantly by cleft type. Logistic regression analysis controlling for multiple variables, showed that Veau IV classification had the highest risk of fistula (OR = 10.582; P = .004). Repair by a specific surgeon was not a significant risk factor for fistula development ( P  > .07 for each surgeon). Conclusions Among six Otolaryngologist‐Head and Neck Surgeons with fellowship training in cleft palate repair postoperative fistula rates were consistent and compared favorably to standards in the Cleft and Craniofacial surgery literature established by other surgical specialties. Consistent with larger database studies involving multiple surgical specialties, Veau IV classification was the strongest predictor of palatal fistula development, even after adjusting for multiple variables, including differing levels of experience. Level of Evidence 4 Laryngoscope , 131:1281–1285, 2021

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