The Role of Prognostic Factors in Perioperative Adverse Events and Complications in Children with Cleft Palate Repair

Yıl 2023, , 313 - 317, 31.08.2023

Elif Eda İci , Demet Laflı Tunay

https://doi.org/10.36516/jocass.1339300

Öz

Aim: Cleft lip and palate (CLP) deformity is the most common type of craniofacial malformation and is usually corrected surgically in infancy. Anesthetic management of children undergoing CLP repair has many challenges. In this study, it was aimed to evaluate the effect of prognostic factors on perioperative complications in children with cleft palate (CP) repair.
Methods: In this study, pediatric cases who underwent cleft palate surgery in a tertiary care hospital between 2015 and 2020 were analyzed retrospectively. The primary outcome measure was perioperative adverse outcomes rate.
Results: The incidence of all perioperative adverse events including airway, and respiratory complications, ICU admission, blood transfusion and re-operation requirement was determined as 40.7% (n=88) and the incidence of respiratory adverse events was found as 28.7% (n=62). Moreover, low body weight (OR 0.69, 95% CI 1.18-1.78, p<0.001), comorbidity, concomitant presence of syndrome (OR 7.19, 95% CI 2.02-25.60, p<0.001) and cleft lip (OR 2.73, 95% CI 1.10–6.73, p=0.030), and complete type of cleft palate (OR 0.33, 95% CI 1.22–7.46, p=0.017) were risk factors for perioperative adverse events.
Conclusions: In this study, a significant relationship was found between underweight, comorbidity, the presence of concomitant syndrome, cleft lip, complete type of cleft palate and the risk of developing perioperative adverse events in children with CP repair.

Anahtar Kelimeler

Cleft palate, cleft lip, difficult airway, perioperative complications, underweight

The Role of Prognostic Factors in Peri¬operative Adverse Events and Complications in Children with Cleft Palate Re¬pair.

Öz

Amaç: Dudak damak yarığı (CLP) deformitesi en sık görülen kraniyofasiyal malformasyon türüdür ve genellikle infant döneminde cerrahi olarak düzeltilir. CLP onarımı geçiren çocukların anestezi yönetimi birçok zorluğu barındırır. Bu çalışmada yarık damak (CP) onarımı uygulanan çocuklarda prognostik faktörlerin perioperatif komplikasyonlara etkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmada 2015-2020 yılları arasında üçüncü basamak bir hastanede yarık damak ameliyatı geçiren çocuk olgular retrospektif olarak incelendi. Birincil sonuç ölçütü, perioperatif olumsuz sonuç oranıydı.
Bulgular: Hava yolu ve solunum komplikasyonları, yoğun bakıma yatış, kan transfüzyonu ve tekrar operasyon gereksinimi dahil olmak üzere tüm perioperatif advers olay insidansı %40,7 (n=88) ve solunumsal komplikasyon insidansı %28,7 (n=62) olarak bulundu. Ayrıca, düşük vücut ağırlığı (OR 0.69, %95 GA 1.18-1.78, p=0.000), komorbidite, eşlik eden sendrom varlığı (OR 7.19, %95 GA 2.02-25.60, p=0.000) ve yarık dudak (OR 2.73, %95 GA 1,10–6,73, p=0,030) ve tam tip yarık damak (OR 0,33, %95 GA 1,22–7,46, p=0,017) perioperatif advers olaylar için risk faktörleriydi.
Sonuç: Bu çalışmada, CP onarımı yapılan çocuklarda düşük kilo, komorbidite, eşlik eden sendrom varlığı, yarık dudak varlığı, komplet tip yarık damak ile perioperatif advers olay gelişme riski arasında anlamlı ilişki bulundu.

Anahtar Kelimeler

Yarık damak, yarık dudak, zor hava yolu, perioperatif komplikasyonlar, zayıflık

Kaynakça

• 1.Tessier P. Anatomical classification facial, cranio-facial and latero-facial clefts. J Maxillofac Surg. 1976; 4(2): 69-92. https://doi.org/10.1016/s0301-0503(76)80013-6
• 2.Marazita ML, Mooney MP. Current concepts in the embryology and genet¬ics of cleft lip and cleft palate. Clin Plast Surg. 2004; 31(2): 125-40. https://doi.org/10.1016/S0094-1298(03)00138-X
• 3.Mai CT, Cassell CH, Meyer RE, et al. Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: highlighting orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014; 100(11): 895-904. https://doi.org/10.1002/bdra.23329
• 4.Murat I, Constant I, Maud'huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth. 2004; 14(2): 158-66. https://doi.org/10.1111/j.1460-9592.2004.01167.x
• 5.Desalu I, Adeyemo W, Akintimoye M, et al. Airway and respiratory compli¬cations in children undergoing cleft lip and palate repair. Ghana Med J. 2010; 44(1): 16-20. https://doi.org/10.4314/gmj.v44i1.68851
• 6.Denning S, Ng E, Wong Riff KWY. Anaesthesia for cleft lip and palate sur-gery. BJA Educ. 2021; 21(10): 384-9. https://doi.org/10.1016/j.bjae.2021.06.002
• 7.Nargozian C. The airway in patients with craniofacial abnormalities. Pae-diatr Anaesth. 2004; 14(1): 53-9. https://doi.org/10.1046/j.1460-9592.2003.01200.x
• 8.Milerad J, Larson O, Hagberg C, et al. Associated malformations in infants with cleft lip and palate: a prospective, population-based study. Pediatrics. 1997; 100(2 Pt 1): 180-6. https://doi.org/10.1542/peds.100.2.180
• 9.Heinrich S, Birkholz T, Ihmsen H, et al. Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures. Paediatr Anaesth. 2012; 22(8): 729-36. https://doi.org/10.1111/j.1460-9592.2012.03813.x
• 10.Mirghassemi A, Soltani AE, Abtahi M. Evaluation of laryngoscopic views and related influencing factors in a pediatric population. Paediatr Anaesth. 2011; 21(6): 663-7. https://doi.org/10.1111/j.1460-9592.2011.03555.x
• 11.Kulkarni KR, Patil MR, Shirke AM, et al. Perioperative respiratory compli¬cations in cleft lip and palate repairs: An audit of 1000 cases under 'Smile Train Project'. Indian J Anaesth. 2013; 57(6): 562-8. https://doi.org/10.4103/0019-5049.123328
• 12.Gunawardana RH. Difficult laryngoscopy in cleft lip and palate surgery. Br J Anaesth. 1996; 76(6): 757-9. https://doi.org/10.1093/bja/76.6.757
• 13.Xue FS, Zhang GH, Li P, et al. The clinical observation of difficult laryngos¬copy and difficult intubation in infants with cleft lip and palate. Paediatr Anaesth. 2006; 16(3): 283-9. https://doi.org/10.1111/j.1460-9592.2005.01762.x
• 14.Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anaesthesia: an au¬dit of 10 000 anaesthetics in Singapore. Paediatr Anaesth. 2001; 11(6): 711-8. https://doi.org/10.1046/j.1460-9592.2001.00767.x
• 15.Escher PJ, Zavala H, Lee D, et al. Malnutrition as a risk factor in cleft lip and palate surgery. Laryngoscope. 2021; 131(6): E2060-5. https://doi.org/10.1002/lary.29209
• 16.Argent AC, Balachandran R, Vaidyanathan B, et al. Management of under¬nutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries. Cardiol Young. 2017; 27(S6): S22-S30. https://doi.org/10.1017/S104795111700258X
• 17.Fraser GR, Calnan JS. Cleft lip and palate: seasonal incidence, birth weight, birth rank, sex, site, associated malformations and parental age. A statistical survey. Arch Dis Child. 1961; 36(188): 420-3. https://doi.org/10.1136/adc.36.188.420
• 18.Kantar RS, Cammarata MJ, Rifkin WJ, et al. Outpatient versus inpatient primary cleft lip and palate surgery: analysis of early complications. Plast Reconstr Surg. 2018; 141(5): 697e-706e. https://doi.org/10.1097/PRS.0000000000004293
• 19.Schultz RC. Management and timing of cleft palate fistula repair. Plast Re¬constr Surg. 1986; 78(6): 739-47. https://doi.org/10.1097/00006534-198678060-00004
• 20.Nagase Y, Natsume N, Kato T, et al. Epidemiological analysis of cleft lip and/or palate by cleft pattern. J Maxillofac Oral Surg. 2010; 9(4): 389-95. https://doi.org/10.1007/s12663-010-0132-6
• 21.Suzuki A, Mukai Y, Ohishi M, et al. Relationship between cleft severity and dentocraniofacial morphology in Japanese subjects with isolated cleft palate and complete unilateral cleft lip and palate. Cleft Palate Craniofac J. 1993; 30(2): 175-81. https://doi.org/10.1597/1545-1569_1993_030_0175_rbcsad_2.3.co_2