The Journal of craniofacial surgery · 2024
Undernutrition in Cleft Palate Surgery: Effects on Postoperative Fistula Formation in a Tertiary Children's Hospital in Southern Africa.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Adams Saleigh, Mahieu Amber, Verreijdt Pien M, Isaacs Samuel, Breugem Corstiaan C
Аннотация
BACKGROUND: Cleft palate surgery can be complicated by fistula development. It is well known that undernutrition in general leads to more postoperative complications. However, little is known about postoperative fistula development after cleft palate surgery in low- and middle-income countries (LMIC's).
OBJECTIVE: The aim of this study was to investigate the influence of peri-operative undernutrition on the risk of postoperative fistula formation in South African children operated on for cleft palate (CP).
DESIGN AND SETTING: Three hundred thirty-seven cleft palate patients undergoing initial cleft palate repair at Red Cross War Memorial Children's Hospital were retrospectively reviewed.
INTERVENTIONS: Undernutrition was measured as World Health Organisation (WHO) Weight-For-Age (WFA) Z-scores, postoperative fistula was noted when the patient received revision surgery for fistula after the initial repair.
MAIN OUTCOME MEASURE: Longitudinal Generalized Estimation Equations (GEE) analysis was used to examine the influence of the undernutrition Z-Score on post-operative fistula formation.
RESULTS: Our cohort had a mean Z-score of -0.873 (SD=1.6043). Among patients undergoing initial cleft palate repair, 21.9% were perioperatively underweight for age (Z-Score < -2), and 8.8% were severely underweight (Z-Score < -3). The cohort had a total symptomatic fistula rate of 19.9%. Decreasing perioperative WFA Z-Score (worsening undernutrition), predicts a significant increase in the odds of postoperative fistula (odds ratio = 1.233, P = 0.018).
CONCLUSIONS: Worsening perioperative undernutrition in initial cleft palate surgery is associated with a significant postoperative increase in fistula formation.
OBJECTIVE: The aim of this study was to investigate the influence of peri-operative undernutrition on the risk of postoperative fistula formation in South African children operated on for cleft palate (CP).
DESIGN AND SETTING: Three hundred thirty-seven cleft palate patients undergoing initial cleft palate repair at Red Cross War Memorial Children's Hospital were retrospectively reviewed.
INTERVENTIONS: Undernutrition was measured as World Health Organisation (WHO) Weight-For-Age (WFA) Z-scores, postoperative fistula was noted when the patient received revision surgery for fistula after the initial repair.
MAIN OUTCOME MEASURE: Longitudinal Generalized Estimation Equations (GEE) analysis was used to examine the influence of the undernutrition Z-Score on post-operative fistula formation.
RESULTS: Our cohort had a mean Z-score of -0.873 (SD=1.6043). Among patients undergoing initial cleft palate repair, 21.9% were perioperatively underweight for age (Z-Score < -2), and 8.8% were severely underweight (Z-Score < -3). The cohort had a total symptomatic fistula rate of 19.9%. Decreasing perioperative WFA Z-Score (worsening undernutrition), predicts a significant increase in the odds of postoperative fistula (odds ratio = 1.233, P = 0.018).
CONCLUSIONS: Worsening perioperative undernutrition in initial cleft palate surgery is associated with a significant postoperative increase in fistula formation.