Is outpatient cleft lip repair associated with increased rates of readmission and reoperation? A retrospective cohort study of 4257 patients.

Abstract

Cleft lip is a common craniofacial anomaly, yet standard practices for cleft lip repair (CLR), particularly regarding inpatient versus outpatient care, remain variable across clinical practice. To determine whether outpatient CLR is associated with increased 30-day readmission or reoperation rates, the National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2014 to 2023. Cases of unilateral (UCLR) and bilateral (BCLR) cleft lip repair were identified and filtered to exclude patients with comorbidities, multiple procedures under the same anesthesia, or inpatient stays longer than one day. Postoperative unplanned readmissions, unplanned reoperations, and the reasons for unplanned admissions and reoperations were evaluated using multivariable analysis. A total of 4257 patients without comorbidities were included (3695 patients underwent UCLR and 562 patients underwent BCLR). Outpatient procedures accounted for 54.5% of UCLR and 55.2% of BCLR. The 30-day unplanned readmission rate was 0.78%, with 54.5% related to the CLR. The unplanned reoperation rate was 0.28%, with 75.0% related to the CLR. Bilateral cleft lip repair was significantly associated with higher odds of unplanned reoperation (OR: 6.61, 95% CI: 2.06-21.10, p = 0.001). Outpatient CLR was not associated with increased risk of unplanned readmission (OR: 0.51, 95% CI: 0.22-1.10, p = 0.09) or reoperation (OR: 2.51, 95% CI: 0.75-11.30, p = 0.17). These findings suggest that outpatient CLR is safe and not associated with increased 30-day complications in healthy patients, supporting the use of outpatient care when appropriate.