Faculty of Medicine, Dalhousie University.
Division of Plastic Surgery, Dalhousie University.
J Craniofac Surg. 2023 May 1;34(3):979-986. doi: 10.1097/SCS.0000000000009094. Epub 2022 Oct 31.
Cleft lip and/or palate repair techniques require continued reevaluation of best practice through high-quality evidence. The objective of this systematic review was to highlight the existing evidence for patient safety and quality improvement (QI) initiatives in cleft lip and palate surgery.
A systematic review of published literature evaluating patient safety and QI in patients with cleft lip and/or palate was conducted from database inception to June 9, 2022, using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using Methodological Index for Non-Randomized Studies, Cochrane, or a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 instruments, according to study type.
Sixty-one studies met inclusion criteria, with most published between 2010 and 2020 (63.9%). Randomized controlled trials represented the most common study design (37.7%). Half of all included studies were related to the topic of pain and analgesia, with many supporting the use of infraorbital nerve block using 0.25% bupivacaine. The second most common intervention examined was use of perioperative antibiotics in reducing fistula and infection (11.5%). Other studies examined optimal age and closure material for cleft lip repair, early recovery after surgery protocols, interventions to reduce blood loss, and safety of outpatient surgery.
Patient safety and QI studies in cleft surgery were of moderate quality overall and covered a wide range of interventions. To further enhance PS in cleft repair, more high-quality research in the areas of perioperative pharmaceutical usage, appropriate wound closure materials, and optimal surgical timing are needed.
唇裂和/或腭裂修复技术需要通过高质量的证据不断重新评估最佳实践。本系统评价的目的是强调唇裂和腭裂手术中患者安全和质量改进（QI）计划的现有证据。
从数据库创建到 2022 年 6 月 9 日，按照系统评价报告的首选条目指南，对评估唇裂和/或腭裂患者患者安全和 QI 的已发表文献进行了系统评价。根据研究类型，使用非随机研究方法学指数、Cochrane 或评估系统评价的测量工具（AMSTAR）2 工具对纳入研究的质量进行评估。
61 项研究符合纳入标准，其中大多数发表于 2010 年至 2020 年（63.9%）。随机对照试验是最常见的研究设计（37.7%）。所有纳入研究中一半与疼痛和镇痛主题有关，许多研究支持使用 0.25%布比卡因进行眶下神经阻滞。检查的第二个最常见干预措施是使用围手术期抗生素减少瘘管和感染（11.5%）。其他研究检查了唇裂修复的最佳年龄和闭合材料、手术后早期恢复方案、减少失血的干预措施以及门诊手术的安全性。
唇裂手术中的患者安全和 QI 研究总体质量中等，涵盖了广泛的干预措施。为了进一步提高唇裂修复的 PS，需要在围手术期药物使用、适当的伤口闭合材料和最佳手术时机等方面进行更多高质量的研究。
