The role of prognostic factors in perioperative adverse events and postoperative complications in children with surgery of cleft palate

Objective: In our study, we aimed to retrospectively analyze the prognostic factors affecting the incidence of perioperative adverse events and postoperative complications in pediatric patients undergoing surgical repair of cleft palate. Material and Method: In our study, demographic data, background information, age and weight data, syndromic status, systemic disease information, intraoperative and postoperative complication data of surgery and anesthesia, preoperative blood preparation data and intraoperative use, cleft lip/palate data and hospitalization information were recorded of pediatric patients who underwent surgical repair of cleft palate at Çukurova University Medical Faculty Hospital between January 2015 and October 2020. Difficult airway, intraoperative blood transfusion, intraoperative bronchospasm, hypothermia, hypercarbia, reintubation status, need for postoperative intensive care, postoperative blood transfusion, need for reoperation, postoperative respiratory distress and other complications were accepted as adverse events. Intraoperative complications, reintubation status and postoperative respiratory distress were evaluated as respiratory complications. Results: In our study, the data of 216 pediatric patients who underwent surgery of cleft palate and ASA I-II group were analyzed. The most common type of cleft palate observed in the patients was incomplete (n=108; 50%) cleft palate, and 42.1% (n=91) of the patients were previously operated for cleft lip. The syndrome was present in 16 (7.4%) patients, the most common being Pierre-Robin syndrome (n=4; 1.9%). Presence of chromosomal anomaly was observed in 1.4% (n=3) of the patients. The rate of patients with systemic disease was 20.8% (n=45) and the most common systemic disease was congenital heart disease (n=24; 11.1%). Difficult mask was observed in only 2 patients (0.9%), while difficult intubation was observed in 12 patients (5.6%) and While 4 patients (1.9%) could not be extubated at the end of the operation, 2 patients (0.9%) were re-intubated after extubation. The most common intraoperative complication was bronchospasm, which was observed in 18.5% (n=40) of the patients; Stridor (5.6%) and rhonchi (5.6%), which were the most common postoperative complications, were seen in 12 patients each. The mean number of intensive care unit hospitalization days of the patients was 1.5±.2 days, and the mean service hospitalization days were 4.7±2.0 days. As a result of the study, the factors increasing the risk of perioperative adverse events were ASA 2 (p=0.001), complete cleft palate type (p=0.003), and operated cleft lip (p=0.001). The risk of developing perioperative respiratory complications increases with low percentile (p=0.004), presence of systemic disease (p=0.001), congenital heart disease (p=0.049) and presence of syndrome (p=0.001). Conclusion: According to the data we obtained as a result of the study, the risk of developing perioperative adverse events and respiratory complications in pediatric patients undergoing surgery of cleft palate is related to these factors; high ASA score, presence of cleft lip with cleft palate, complete type of cleft palate, low weight percentile, presence of systemic disease, presence of congenital heart disease and syndrome. Key Words: Cleft Lip, Cleft Palate, Difficult Airway, Perioperative Complications