Balkin, Daniel M. MD, PhD; Incorvia, Joseph MScGH; Reed, Brianna BS; Nuzzi, Laura C. BA; Hughes, Christopher D. MD, MPH; Catallozzi, Liza MS, CCC-SLP; Clark, Roseanne MS, CCC-SLP; Kummer, Ann W. PhD, CCC-SLP, FASHA∥; Meara, John G. MD, DMD, MBA
Background:
No widely applied standardized outcome metric exists following palatoplasty. We created a novel quality metric, optimal outcome reporting (OOR), reflecting patients who experienced the best outcome: normal velopharyngeal function and no unintended fistula after a single operation. We assessed OOR at 5 and 8 years of age in a patient cohort.
Methods:
Data collected included sex, ethnicity, Veau classification, syndromic status, operative age, presence of fistulae, and speech assessments at 5 and 8 years. Patients with submucous clefts were excluded.
Results:
The cohort comprised 94 patients. Median operative age was 10 months; 45% were male, 46% were non-White, and 25% had syndromic diagnoses. The most common cleft types were Veau I (32%) and Veau III (28%). At 5 years, 69% (65 of 94) achieved OOR, with suboptimal outcomes due to multiple operations (9), velopharyngeal insufficiency (19), or fistula (1). At 8 years, 73% (61 of 83) met OOR criteria; failures resulted from multiple operations (12), velopharyngeal insufficiency (9), or fistula (1). Patients with OOR were significantly younger at the time of palate repair. A higher proportion of patients with nonsyndromic diagnoses and those with Veau I/III clefts attained OOR compared with patients with syndromic diagnoses and other cleft types. Nine patients with speech-related suboptimal outcomes at 5 years demonstrated optimal outcomes by 8 years with speech therapy alone.
Conclusions:
Cleft palate OOR describes the ideal outcome following primary palatoplasty. This simple surgical outcome metric can be applied to individual surgeons and across centers, facilitating benchmarking and quality improvement initiatives.
