Back to the Bottle: Comparison of Palatoplasty Outcomes Before and After Systematic Changes to Postoperative Precaution Protocols.

Main objective: To analyze postoperative palatoplasty outcomes before and after systemic protocol changes to preferred bottle and arm immobilizer use after surgery.

Design: Retrospective, cohort study.

Setting: Urban, academic, tertiary medical center in New York City, NY.

Participants: Eighty-four patients who underwent primary palatoplasty and met inclusion criteria during 1 of 2 treatment periods, 2016 to 2017 (group A, n = 45) and 2019 to 2020 (group B, n = 39).

Interventions: Protocols were amended over the 2018 calendar year to allow for utilization of the baby's preferred bottle (vs alternative feeding methods) and hand socks (vs arm immobilizers) in the immediate postoperative period. Data was extrapolated from electronic medical records to compare surgical outcomes.

Main outcome measures: Postoperative wound complications (fistula and dehiscence) that did not resolve within 1 month, length of stay (hours), and 30-day re-admission. Nonparametric Mann-Whitney U tests and Fisher's Exact test were utilized for statistical analysis.

Results: There were no statistically significant differences between sex, age at surgery, Veau classification, or hard and soft palate surgical repair technique. Group A had a wound complication rate of 8.7% (n = 4) versus a 2.6% rate (n = 1) for group B. No patients were re-admitted to the hospital from either group. There were no statistically significant differences between groups regarding length of stay (P = .528) or wound complication (P = .366).

Conclusions: The findings from this study suggest relaxing postoperative protocols following palatoplasty to allow immediate bottle feedings and unrestricted arm use may be safe without compromise to surgical outcomes.