A National Comparison of Inpatient and Outpatient Procedures for Correcting Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) may follow cleft palate repair often requiring surgical intervention to minimize impaired speech production.1 This study investigates current practices in outpatient versus inpatient surgical management of VPI. While commonly performed, these interventions are not free from postoperative complications requiring inpatient management.2 A retrospective review of the National Surgical Quality Improvement Program-Pediatric database was conducted on pediatric patients who underwent VPI-correcting surgery from 2012 to 2020. Entropy balancing was performed to match inpatient and outpatient cohorts based on demographics and comorbidities. Patients were then categorized as either same-day discharge or overnight observation. Outcomes of interest included 30-day readmission and postoperative complication rates. Univariate analysis and multivariate regression were performed. Upon review, 3,952 patients underwent VPI-correcting surgery, with 1,976 in each matched hospital setting cohort. Thirty-day readmission and major complication rates between inpatient and outpatient cohorts were 1.8% (2.2% vs 1.5%; P = .096) and 1.2% (1.8% vs 0.6%; P < .001), respectively. Most complications were respiratory-related (58.7%) or wound-related (54.3%). Among the outpatient cohort, 1,507 (76.3%) patients required at least 1 night of overnight observation; all inpatients were admitted and monitored for at least 1 night. Upon multivariate regression of this outpatient subgroup, both oxygen dependence and preoperative steroid use significantly increase patients’ risk of readmission (oxygen dependence: Adjusted OR [aOR] = 6.096, P = .045; steroid use aOR = 8.593, P = .008) and postoperative complications (oxygen dependence: aOR 11.515, P = 0.002; steroid use: aOR = 8.593, P = .008). Approximately 88% of patients required at least 1 night of overnight observation regardless of the hospital setting. Outpatients with baseline airway compromise (ie, at-home oxygen dependence and steroid use) had an increased risk of 30-day readmission and postoperative complications. Thus, inpatient VPI-correcting surgery should remain the standard of care as adequate resources are available to mitigate life-threatening complications if they arise. Table 1Stepwise Logistic Regression of Patient Factors Associated with 30-Day Readmission among Outpatients who Required Overnight Observation Open table in a new tab Table 2Stepwise Logistic Regression of Patient Factors Associated with 30-Day Major Postoperative Complications among Outpatients who Required Overnight Observation Open table in a new tab