DOES REDUCED HOSPITAL STAY AFFECT MORBIDITY AND MORTALITY-RATES FOLLOWING CLEFT-LIP AND PALATE REPAIR IN INFANCY

Insurance carriers affected decisions regarding admissions and length of stay in our hospital in 1987. Charts were reviewed retrospectively to determine whether this affected morbidity and mortality rates follo wing cleft lip and palate operations in infants. Two periods were stud ied: May of 1983 through April of 1981 (group I) and April of 1987 thr ough May of 1991 (group II). A total of 248 infants with cleft lip and /or palate underwent 398 operations: lip adhesion (74), definitive lip repair (130), and palatoplasty (194). Half were performed in each per iod. Admission status, length of stay, length of operation, and short- term morbidity were documented. Morbidity included spontaneous and tra umatic lip dehiscence, palatal dehiscence, and palatal fistula. Interg roup analysis was performed by the chi-squared method; p less than or equal to 0.05 was statistically significant. In group I, 93 percent of patients were admitted before surgery. In group II, 5 percent were ad mitted before surgery and 79 percent the day of surgery. Hospital stay decreased nearly 2 days for each operation. There was no statisticall y significant difference between groups in distribution of operations, length of operations, or morbidity: lip surgery complications (p = 0. 263), palatoplasty complications (p = 0.624). Reductions of hospital a dmissions and length of stay do not affect outcome of cleft lip and pa late surgery in infants. The reduction in hospital days is equivalent to a savings of $138,000 (1991 dollars).