BACKGROUND AND SIGNIFICANCE: Almost 15% of newborns have congenital anomalies that involve the oral and craniofacial regions, but of these congenital anomalies, cleft lip and palate and craniosynostosis are the most common. It is estimated that the incidence of cleft lip and palate is 0.664 in 1000 live births. These patients commonly have skeletal imbalances of the maxillae and mandible that require surgical and orthodontic correction. Orthodontists and oral surgeons play a critical role in identifying the necessary care and ensuring that the patient receives the best quality of care possible.
OBJECTIVES: The objective of the current study is to examine the prevalence of adverse effects of medical care and infectious complications in patients with cleft lip/palate undergoing facial bone repairs/orthognathic surgeries in the United States during the years 2012 to 2014. It will also examine the association between patient/hospital related factors and surgical outcomes (including adverse affects of surgery, incidence of infection, etc.) and how these surgical outcomes impact the hospital costs and length of stay in the hospital.
MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) is a 20% stratified probability sample of hospitalizations occurring in all acute care hospitals in the United States. It is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) [12]. Each hospital in this sample provides information on 20% of hospitalizations occurring during the select years. Hospital stratification is based on multiple hospital-associated variables including: hospital location, geographic region, bed size, teaching status, and ownership/control. Each hospitalization is assigned a sampling weight. Patient-related variables are also provided by the hospitals. In this study, this information is used to provide a nationally representative estimate of all hospitalizations and associated outcomes in the United States from 2012-2014.
RESULTS: This study includes all 1,785 patients with cleft lip/palate undergoing facial bone repair/orthognathic surgical procedures in the United States during the study period (2012-2014). These results confirm the hypothesis that there are a combination of patient and hospital related factors that contribute to the occurrence of adverse events and that the occurrence of these events is associated with substantial increases in hospital charges and length of hospital stay.
CONCLUSION: These study results are a national representative sample of patients with cleft lip/palate undergoing bony facial repair and orthognathic surgery. They reflect the practice patterns and hospitalization outcomes across the United States. These results can serve as a platform for future prospective controlled studies to examine the risk factors associated with adverse effects of medical care for a wide range of surgical procedures. This information is useful for clinicians, health policy makers, and patients so that they can make informed treatment and policy decisions as well as continue to improve surgical procedures and outcomes.