ArticleBMJ paediatrics open2017
Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study.
Article in BMJ paediatrics open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
5 citing papers in PubMed.
- A Comparative Study of Cleft Management in Different Economic Settings: United States Versus Guatemala.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2026Article
- Predictors of Poor Speech Outcomes Following Primary Palatoplasty for Patients with Cleft Palate: Do Social Determinants of Health Impact Velopharyngeal Insufficiency?Plastic surgery (Oakville, Ont.) · 2026Article
- Analysis and Reporting of Randomized Trials in Cleft Palate Surgery: Learning from the Timing of Primary Surgery (TOPS) Trial.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2025Article
- Non-Interventional Factors Influencing Velopharyngeal Function For Speech In Initial Cleft Palate Repair: A Systematic Review Protocol.Systematic reviews · 2019Article
- Five-Fold Variation Among Surgeons and Hospitals in the Use of Secondary Palate Surgery.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2019Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectivesTo test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital- and surgeon-factors that are associated with use of secondary surgery.
designRetrospective cohort study.
settingForty-three paediatric hospitals across the United States. PATIENTS: Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013.
main outcome measuresTime from primary cleft palate repair to secondary palate surgery.
resultsWe identified 4,939 children who underwent primary cleft palate repair. At ten years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (p<0.001); the proportion of children undergoing secondary surgery by 10 years ranged from 9% to 77% across hospitals. After adjusting for patient demographics, primary palate repair before nine months of age was associated with an increased hazard of secondary palate surgery (initial hazard ratio 6.74, 95% CI 5.30-8.73). Postoperative antibiotics, surgeon procedure volume, and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (p<0.001), while between-surgeon differences accounted for 41% (p<0.001).
conclusionsSubstantial variation in the hazard of secondary palate surgery exists depending on a child's age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before nine months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons.
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