From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles; the Division of Plastic and Reconstructive Surgery, University of Southern California; the Division of Plastic and Reconstructive Surgery, Loma Linda University Medical Center; the Keck School of Medicine of the University of Southern California; and the Division of Plastic and Reconstructive Surgery, Southern California Permanente Medical Group.
Plast Reconstr Surg. 2018 Jul;142(1):159-168. doi: 10.1097/PRS.0000000000004473.
There is no accepted protocol for inpatient versus ambulatory cleft lip surgery. The aim of this study was to review the safety of outpatient repair and develop guidelines.
A retrospective review of patients younger than 2 years undergoing primary cleft lip repair from 2008 to 2015 at six centers was performed. Patients were divided into two groups: predominantly ambulatory (discharged or admitted for specific concerns) and inpatient (admitted due to surgeon's preference). The impact of independent variables on admission, emergency department visits, and readmission within 1 month of discharge was analyzed.
Of 546 patients, 68.1 percent were boys, 4.4 percent had syndromes, and 23.6 percent had comorbidities. One hundred forty-two patients were admitted postoperatively. Forty-nine admissions were attributable to the surgeon's preference. After excluding this subset, our ambulatory surgery rate was 81 percent. There was no difference in emergency department visits (3 percent versus 2.2 percent; p = 0.6) or readmissions (0 percent versus 1.45 percent; p = 0.5) between groups. None of the ambulatory surgery patients were readmitted within 36 hours, for a successful ambulatory surgery rate of 100 percent. Female sex; surgical time; prematurity and/or postconceptional age younger than 52 weeks; and cardiac, respiratory, central nervous system, gastrointestinal, genitourinary, and other congenital comorbidities had significant impact on admission rates in the predominantly ambulatory group (p < 0.05). Respiratory comorbidities and syndromes were risk factors for readmission if patients presented to the emergency department (p < 0.05).
Ambulatory cleft lip repair can be performed safely in most patients with no difference in emergency department visits or readmission. Patients with comorbidities should be admitted for observation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
目前对于择期进行门诊或住院唇裂修复术并无统一的标准。本研究旨在评估门诊修复术的安全性并制定相应的指南。
对 2008 年至 2015 年期间在六个中心接受初次唇裂修复术且年龄小于 2 岁的患者进行回顾性研究。根据患者是否为日间手术（即出院或因特定问题而入院）或住院手术（即因医生偏好而入院）分为两组。分析了独立变量对入院、急诊就诊和出院后 1 个月内再入院的影响。
546 例患者中，68.1%为男性，4.4%患有综合征，23.6%合并其他疾病。术后有 142 例患者入院。其中 49 例入院归因于医生的偏好。排除这部分患者后，日间手术率为 81%。两组患者的急诊就诊率（3%比 2.2%；p=0.6）和再入院率（0%比 1.45%；p=0.5）无差异。所有日间手术患者均未在 36 小时内再次入院，日间手术成功率为 100%。女性、手术时间、早产且/或胎龄小于 52 周、以及心脏、呼吸、中枢神经系统、胃肠道、泌尿生殖系统和其他先天性合并症是日间手术组入院率的显著影响因素（p<0.05）。如果患者就诊于急诊，呼吸系统合并症和综合征是再入院的危险因素（p<0.05）。
在大多数患者中，门诊唇裂修复术是安全可行的，其急诊就诊率和再入院率无差异。有合并症的患者应入院观察。
临床问题/证据水平：治疗性，IV。
