title: Evaluating the Need for Routine Admission following Primary Cleft Palate Repair: An Analysis of 100 Consecutive Cases.
abstract: BACKGROUND
  Routine admission following primary cleft palate repair is the standard of care at most institutions. Insurance companies have demonstrated increasing resistance to hospitalization longer than a "short stay"(23 hour) observation period following palatoplasty. The purpose of this study was to identify factors related to length of stay following palate repair.
  
  
  METHODS
  Retrospective chart review was conducted for 100 consecutive patients undergoing primary cleft palate repair from May 2009 to February 2013. Demographic and perioperative data were collected and two-sample Student t-test, univariate and multivariable linear regression models were performed to assess for correlation with longer length of stay.
  
  
  RESULTS
  Mean age at the time of surgery was 12.6 months. Median length of stay was 39 hours; all 100 patients had >23 hours length of stay. Seventy-three percent of patients required intravenous fluids greater than 23 hours after admission. Postoperative intravenous narcotics were required in 92 percent of patients after transfer to the post-surgical floor, and the last dose was given on average 19.8 hours after completion of surgery. There were 13 patients who required postoperative supplemental oxygen for greater than 23 hours following admission. Multivariable predictors of increased length of stay included female gender, syndromic diagnosis, longer operative and anesthetic durations, longer time to postoperative oral intake, and lower dose of postoperative intravenous narcotic.
  
  
  CONCLUSIONS
  Factors identified in association with increased length of stay may guide opportunities for reducing postoperative hospitalization; however, these findings would oppose the safety of routine ambulatory surgery or short-stay observation following primary cleft palate repair.
  
  
  METHODS
  Risk, III.
authors.affiliation: Washington, D.C.; and Boston, Mass. From the Division of Plastic Surgery, Children's National Medical Center; and Boston Children's Hospital, Harvard Medical School.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Wood
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boyajian
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: Albert K
authors.initials: AK
authors.lastname: Oh
mesh_terms: D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies