Global Increase in Oronasal Fistula Rates Following Cleft Palate Repair: A Systematic Review and Meta-Analysis of Reported Fistula Rates.

ObjectiveOronasal fistula (ONF) rates after primary palatoplasty may be influenced by technique improvements and care expansion. We evaluated the temporal and geospatial patterns of ONF.DesignA systematic review and meta-analysis were performed of publications between January 1960 and November 2024 that reported fistula rate following cleft palate repair.SettingN/A.PatientsPatients with cleft palate.InterventionsPrimary palatoplasty.Main Outcome Measure(s)Fistula rate.Results223 publications with 71,238 patients were included. Median fistula rates decreased from the 1960s (13.9%, n = 2) to the 2000s (4.9%, IQR: 2.9%-11.0%). Fistula rates increased significantly in the 2010s (6.7%, IQR: 2.6-14.0%), and continued to increase in the 2020s (10.7%, IQR: 5.7-20.5%, p = 0.005). Fistula rates among European nations showed the largest increase from the 2000s (4.4%, IQR: 2.0-12.5%) to the 2020s (21.1%, IQR: 12.7-49.4%, p = 0.041).ConclusionsReported fistula incidence declined from reports in the 1960s through the 2000s but has since increased.