Objective: To perform a systematic review and meta-analysis to determine if day case cleft lip surgery has an impact on complications and 30-day readmission rate.
Design: A systematic review was conducted using PRISMA guidelines. Databases included; PubMed, Science Direct, Ovid and Cochrane. Search terms; "Day Case", "Day Care", "outpatient", "Ambulatory" AND "Cleft", "Cleft Lip". Meta-analysis was performed using RevMan 5.
Setting: Eligible study types included; randomised controlled trials, observational studies (prospective and retrospective) and case series.
Patients/participants: Paediatric patients undergoing primary cleft lip repair.
Interventions: Day case surgery versus inpatient admission post-operative.
Main outcome measure(s): Primary outcome measure: Primary cleft lip repair performed as a day case in paediatric patients. Secondary outcome measures: 1. Complication rates and 30-day re-admission to hospital rate. 2. Patient suitability for day case surgery.
Results: Ten papers with 13 804 patients undergoing primary cleft lip repair were included, 28% were discharged on the day of surgery (Range 17%-81%). There was no significant difference in complication rate between the inpatient and day case cohorts. There was a significant reduction in 30-day readmission rates in the day case cohort.
Conclusions: This meta-analysis indicates there is no difference in complication rates for patients discharged on the day of surgery compared to those admitted overnight. Complications encountered were infrequent, non-life threatening and often occurred more than 24 h following discharge. There was an observed reduction in 30-day readmission rates for day-case patients. This is likely to represent a variation in baseline characteristics which deemed them suitable for day case surgery pre-operatively.
Keywords: cleft lip; cleft lip and palate; health policies; outcomes; pediatrics; quality improvement; retrospective study; surgical complications; systematic review; team care.