title: Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery.
abstract: BACKGROUND
  This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges.
  
  
  METHODS
  The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges.
  
  
  RESULTS
  The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges.
  
  
  CONCLUSIONS
  Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.
authors.affiliation: Philadelphia, Pa.|From the Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Cassandra A
authors.initials: CA
authors.lastname: Ligh
authors.affiliation: Philadelphia, Pa.|From the Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.affiliation: Philadelphia, Pa.|From the Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Jordan
authors.initials: J
authors.lastname: Swanson
authors.affiliation: Philadelphia, Pa.|From the Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Yu
authors.affiliation: Philadelphia, Pa.|From the Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D002972:Cleft Palate / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014481:United States; D014600:Utilization Review