Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis
Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using na...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2020-12, Vol.146 (6), p.1340-1346 |
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| creator | Makar, Katelyn G. Waljee, Jennifer F. Kasten, Steven J. Buchman, Steven R. Vercler, Christian J. |
| description | Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.
The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.
Therapeutic, III. |
| doi_str_mv | 10.1097/PRS.0000000000007339 |
| format | Article |
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The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.
Therapeutic, III.</description><identifier>ISSN: 0032-1052</identifier><identifier>EISSN: 1529-4242</identifier><identifier>DOI: 10.1097/PRS.0000000000007339</identifier><identifier>PMID: 33234965</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Administrative Claims, Healthcare - statistics & numerical data ; Aftercare - statistics & numerical data ; Child ; Child, Preschool ; Cleft Palate - surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Oral Surgical Procedures - adverse effects ; Palate, Soft - surgery ; Pharynx - surgery ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Reoperation - adverse effects ; Retrospective Studies ; Speech Disorders - etiology ; Speech Disorders - surgery ; Surgical Flaps - transplantation ; Treatment Outcome ; Velopharyngeal Insufficiency - diagnosis ; Velopharyngeal Insufficiency - etiology ; Velopharyngeal Insufficiency - surgery</subject><ispartof>Plastic and reconstructive surgery (1963), 2020-12, Vol.146 (6), p.1340-1346</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3521-4cce9248ec8a9846b4b12d21763ae1c29359de015abbd1e7fd1e5e4bb4b238073</citedby><cites>FETCH-LOGICAL-c3521-4cce9248ec8a9846b4b12d21763ae1c29359de015abbd1e7fd1e5e4bb4b238073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33234965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Makar, Katelyn G.</creatorcontrib><creatorcontrib>Waljee, Jennifer F.</creatorcontrib><creatorcontrib>Kasten, Steven J.</creatorcontrib><creatorcontrib>Buchman, Steven R.</creatorcontrib><creatorcontrib>Vercler, Christian J.</creatorcontrib><title>Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis</title><title>Plastic and reconstructive surgery (1963)</title><addtitle>Plast Reconstr Surg</addtitle><description>Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.
The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.
Therapeutic, III.</description><subject>Administrative Claims, Healthcare - statistics & numerical data</subject><subject>Aftercare - statistics & numerical data</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cleft Palate - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Oral Surgical Procedures - adverse effects</subject><subject>Palate, Soft - surgery</subject><subject>Pharynx - surgery</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Reoperation - adverse effects</subject><subject>Retrospective Studies</subject><subject>Speech Disorders - etiology</subject><subject>Speech Disorders - surgery</subject><subject>Surgical Flaps - transplantation</subject><subject>Treatment Outcome</subject><subject>Velopharyngeal Insufficiency - diagnosis</subject><subject>Velopharyngeal Insufficiency - etiology</subject><subject>Velopharyngeal Insufficiency - surgery</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNFu2yAUhtG0aU27vcE0cdkbWjhgO-wuipq1UtRNS3ttYXzceMPGBVtRbvbsJWnXTUOCA-g_H-Ij5JPgF4Lr4vL7j80F_2cUUuo3ZCYy0EyBgrdkxrkEJngGJ-Q0xp-ci0Lm2XtyIiVIpfNsRn4vfTe41pqx9X2kpq_puEV6i1jTxge69v0Du8PQ0ZV3zu_Y_UBNM2KgG7S-r03Y082AaLd0M4UHDPsvdEFvjzjjjrwDoh2nuj1cLJ1pu0gXab-PbfxA3jXGRfz4Us_I_erqbnnN1t--3iwXa2ZlBoIpa1GDmqOdGz1XeaUqATWIIpcGhQUtM10jF5mpqlpg0aQlQ1WlHMh5UnNGzp-5Q_CPE8ax7Npo0TnTo59iCSpXQnMpeIqq56gNPsaATTmEtkv_LAUvD-bLZL7833xq-_zywlR1WL82_VH9l7vzLvmLv9y0w1Bu0bhxe-SlkGLAgQtIJ5YmCPkEUsaOhQ</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Makar, Katelyn G.</creator><creator>Waljee, Jennifer F.</creator><creator>Kasten, Steven J.</creator><creator>Buchman, Steven R.</creator><creator>Vercler, Christian J.</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201201</creationdate><title>Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis</title><author>Makar, Katelyn G. ; Waljee, Jennifer F. ; Kasten, Steven J. ; Buchman, Steven R. ; Vercler, Christian J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3521-4cce9248ec8a9846b4b12d21763ae1c29359de015abbd1e7fd1e5e4bb4b238073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Administrative Claims, Healthcare - statistics & numerical data</topic><topic>Aftercare - statistics & numerical data</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cleft Palate - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Oral Surgical Procedures - adverse effects</topic><topic>Palate, Soft - surgery</topic><topic>Pharynx - surgery</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Reoperation - adverse effects</topic><topic>Retrospective Studies</topic><topic>Speech Disorders - etiology</topic><topic>Speech Disorders - surgery</topic><topic>Surgical Flaps - transplantation</topic><topic>Treatment Outcome</topic><topic>Velopharyngeal Insufficiency - diagnosis</topic><topic>Velopharyngeal Insufficiency - etiology</topic><topic>Velopharyngeal Insufficiency - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Makar, Katelyn G.</creatorcontrib><creatorcontrib>Waljee, Jennifer F.</creatorcontrib><creatorcontrib>Kasten, Steven J.</creatorcontrib><creatorcontrib>Buchman, Steven R.</creatorcontrib><creatorcontrib>Vercler, Christian J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Makar, Katelyn G.</au><au>Waljee, Jennifer F.</au><au>Kasten, Steven J.</au><au>Buchman, Steven R.</au><au>Vercler, Christian J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>146</volume><issue>6</issue><spage>1340</spage><epage>1346</epage><pages>1340-1346</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.
The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.
Therapeutic, III.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33234965</pmid><doi>10.1097/PRS.0000000000007339</doi><tpages>7</tpages></addata></record> |
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| subjects | Administrative Claims, Healthcare - statistics & numerical data Aftercare - statistics & numerical data Child Child, Preschool Cleft Palate - surgery Female Follow-Up Studies Humans Infant Male Oral Surgical Procedures - adverse effects Palate, Soft - surgery Pharynx - surgery Postoperative Complications - diagnosis Postoperative Complications - epidemiology Postoperative Complications - etiology Reoperation - adverse effects Retrospective Studies Speech Disorders - etiology Speech Disorders - surgery Surgical Flaps - transplantation Treatment Outcome Velopharyngeal Insufficiency - diagnosis Velopharyngeal Insufficiency - etiology Velopharyngeal Insufficiency - surgery |
| title | Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis |
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