Effect of Hospital Volume on Outcomes of Surgery for Cleft Lip and Palate.
OBJECTIVE
Cleft lip and cleft palate are the most common craniofacial anomalies. However, the effect of hospital volume on outcomes of surgery for cleft lip and palate is unknown.


METHODS
The Japanese Diagnosis Procedure Combination database was searched to identify patients who underwent surgery for cleft lip and palate from July 2010 through March 2013. Hospital volume was divided into tertiles (≤28, 29 to 82, and ≥83 admissions/yr). Outcomes included total cost, length of hospital stay, duration of anesthesia, and length of antibiotic use. The relation between hospital volume and surgical outcomes was analyzed by multivariable regression analyses.


RESULTS
The authors identified 7,405 admissions for cleft lip alone, cleft palate alone, or cleft lip and palate during the study period. Compared with the reference low-volume hospital category, a shorter duration of anesthesia was seen in the medium-volume group (-15 minutes; 95% confidence interval, -37 to 7 minutes) and high-volume group (-22 minutes; 95% confidence interval, -65 to 3 minutes). No statistical associations were observed between hospital volume and total cost or length of stay. Although not statistically important, a higher hospital volume was associated with a shorter length of antibiotic use after adjusting for duration of anesthesia.


CONCLUSIONS
In the present study of surgical outcomes for cleft lip and palate, hospital volume was inversely associated with duration of anesthesia and length of antibiotic use, but was not statistically associated with length of hospital stay or total cost.
Graduate Student, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Sachiko
S
Ono
Graduate Student, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Miho
M
Ishimaru
Assistant Professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Hiroki
H
Matsui
Professor, Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
Kiyohide
K
Fushimi
Professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. Electronic address: yasunagah-tky@umin.ac.jp.
Hideo
H
Yasunaga
D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006761:Hospitals; D006801:Humans; D007564:Japan; D008297:Male