title: Effect of Surgeon Volume and Craniofacial Fellowship Training on Cleft Palate Complication Rates.
abstract: BACKGROUND
  Both the general and pediatric surgical literature have evidenced an inverse relationship between surgical case volume and complications. This study seeks to ascertain the relationship between case volume and fistula rates in cleft palate patients. We also seek to determine if craniofacial fellowship training impacts fistula rates.
  
  
  METHODS
  Charts were reviewed at a multidisciplinary cleft center in San Diego, CA. We performed chart review on 207 nonsyndromic patients with cleft lip and palate who had surgery at our institution from 1988 to 2010. Data were analyzed using independent samples t test, χ test, and stepwise binary logistic regression to assess whether surgeon case volume and craniofacial fellowship training correlated with fistula repair rate.
  
  
  RESULTS
  The surgeon with the highest volume had significantly fewer fistula repairs than lower volume surgeons (P = 0.044). Patients operated on by the craniofacial fellowship trained surgeon had significantly fewer fistulas compared with other plastic surgeons who performed cleft palate surgery (P = 0.005).
  
  
  CONCLUSIONS
  Based on our retrospective review, it does appear that both high case volume and craniofacial fellowship training are associated with fewer postoperative fistulas.
authors.affiliation: From the *Division of Plastic Surgery, University of California San Diego, School of Medicine, La Jolla; †Divisions of Plastic Surgery and Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, CA; and ‡Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Schoenbrunner
authors.forename: Cecilia L
authors.initials: CL
authors.lastname: Dalle Ore
authors.forename: Samuel
authors.initials: S
authors.lastname: Lance
authors.forename: Joyce
authors.initials: J
authors.lastname: McIntyre
authors.forename: Marilyn
authors.initials: M
authors.lastname: Jones
authors.forename: Amanda
authors.initials: A
authors.lastname: Gosman
mesh_terms: D002140:California / Q000453:epidemiology; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000193:education*; D012189:Retrospective Studies; D016526:Workload