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, 57 (2), 198-207

Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery


Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery

Thomas J Sitzman et al. Cleft Palate Craniofac J.


Objective: To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery.

Design: Retrospective cohort study.

Setting: Forty-nine pediatric hospitals.

Participants: Children who underwent cleft lip repair between 1999 and 2015.

Main outcome measure: Time from primary cleft lip repair to secondary lip surgery.

Results: By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals.

Conclusions: There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.

Keywords: cleft lip; health services; secondary surgery.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest relevant to this article to disclose.

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