Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis
Objective Cleft lip and palate significantly impact a child’s speech and facial appearance. Children undergo cleft repairs in infancy, but poor results from these initial repairs often lead to secondary surgery. In the late 1990s, cleft care provision in the UK was centralised to approximately 11 ma...
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| Format: | Article |
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BMJ Publishing Group
2025-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/8/e105396.full |
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| author | Debbie Sell Thomas J Sitzman Andrew Keith Wills Stu Toms Jonathan R Sandy Jessica L Chee-Williams M’hamed Temkit |
| author_facet | Debbie Sell Thomas J Sitzman Andrew Keith Wills Stu Toms Jonathan R Sandy Jessica L Chee-Williams M’hamed Temkit |
| author_sort | Debbie Sell |
| collection | DOAJ |
| description | Objective Cleft lip and palate significantly impact a child’s speech and facial appearance. Children undergo cleft repairs in infancy, but poor results from these initial repairs often lead to secondary surgery. In the late 1990s, cleft care provision in the UK was centralised to approximately 11 managed clinical networks or centres. This centralisation has been associated with improvements in speech and aesthetic outcomes, but little is known about the effect of centralisation on the use of secondary surgery. The purpose of this study was to compare the cumulative incidence of secondary cleft surgeries before and after centralisation and the proportion of children achieving good clinical outcomes without secondary surgery.Design Retrospective, cross-sectional.Setting and participants Two cross-sectional studies of 5-year-old children with non-syndromic unilateral cleft lip and palate were conducted, one precentralisation and one postcentralisation.Outcome measures The cumulative incidence of secondary surgery from birth through age 5 was compared precentralisation and postcentralisation using Fisher’s exact test, as were facial appearance and speech outcomes at age 5. Risk ratios (RR) were estimated using log-binomial multivariable regression models that adjusted for sex and age at evaluation.Results Postcentralisation, the proportion of children achieving good or excellent facial appearance increased from 16% to 42% (p<0.0001), good speech outcomes improved from 82% to 90% (p=0.02) and those avoiding secondary surgery rose from 45% to 67% (p<0.0001). The risk of secondary surgery decreased by 40% (RR: 0.60; 95% CI: 0.48 to 0.74), with notable reductions for secondary lip, palate and nose surgeries (RR: 0.19, 0.54 and 0.13, respectively; p<0.0001). The proportion of children achieving an ideal surgical outcome—good facial appearance, good speech and no secondary surgery—increased from 7% precentralisation to 28% postcentralisation (p=0.01; 4.1-fold increase).Conclusions Centralisation of cleft care was associated with improved outcomes of primary lip and palate repairs and a corresponding reduction in secondary surgery. |
| format | Article |
| id | doaj-art-8be3c849344b4419b7f6c2ee3362d2c3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8be3c849344b4419b7f6c2ee3362d2c32025-08-20T03:36:42ZengBMJ Publishing GroupBMJ Open2044-60552025-08-0115810.1136/bmjopen-2025-105396Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysisDebbie Sell0Thomas J Sitzman1Andrew Keith Wills2Stu Toms3Jonathan R Sandy4Jessica L Chee-Williams5M’hamed Temkit6Great Ormond Street Hospital for Children, London, UKPhoenix Children`s Center for Cleft and Craniofacial Care, a Division of Plastic Surgery, Phoenix Children`s Hospital, Phoenix, Arizona, USAFaculty of Health & Sport Science, University of Agder, Kristiansand, NorwayBristol Dental School, University of Bristol, Bristol, UKFMedSci, Emeritus Professor in Orthodontics, The Cleft Collective, University of Bristol, Bristol, UKPhoenix Children`s Center for Cleft and Craniofacial Care, a Division of Plastic Surgery, Phoenix Children`s Hospital, Phoenix, Arizona, USADepartment of Clinical Research, Phoenix Children’s Hospital, Phoenix, Arizona, USAObjective Cleft lip and palate significantly impact a child’s speech and facial appearance. Children undergo cleft repairs in infancy, but poor results from these initial repairs often lead to secondary surgery. In the late 1990s, cleft care provision in the UK was centralised to approximately 11 managed clinical networks or centres. This centralisation has been associated with improvements in speech and aesthetic outcomes, but little is known about the effect of centralisation on the use of secondary surgery. The purpose of this study was to compare the cumulative incidence of secondary cleft surgeries before and after centralisation and the proportion of children achieving good clinical outcomes without secondary surgery.Design Retrospective, cross-sectional.Setting and participants Two cross-sectional studies of 5-year-old children with non-syndromic unilateral cleft lip and palate were conducted, one precentralisation and one postcentralisation.Outcome measures The cumulative incidence of secondary surgery from birth through age 5 was compared precentralisation and postcentralisation using Fisher’s exact test, as were facial appearance and speech outcomes at age 5. Risk ratios (RR) were estimated using log-binomial multivariable regression models that adjusted for sex and age at evaluation.Results Postcentralisation, the proportion of children achieving good or excellent facial appearance increased from 16% to 42% (p<0.0001), good speech outcomes improved from 82% to 90% (p=0.02) and those avoiding secondary surgery rose from 45% to 67% (p<0.0001). The risk of secondary surgery decreased by 40% (RR: 0.60; 95% CI: 0.48 to 0.74), with notable reductions for secondary lip, palate and nose surgeries (RR: 0.19, 0.54 and 0.13, respectively; p<0.0001). The proportion of children achieving an ideal surgical outcome—good facial appearance, good speech and no secondary surgery—increased from 7% precentralisation to 28% postcentralisation (p=0.01; 4.1-fold increase).Conclusions Centralisation of cleft care was associated with improved outcomes of primary lip and palate repairs and a corresponding reduction in secondary surgery.https://bmjopen.bmj.com/content/15/8/e105396.full |
| spellingShingle | Debbie Sell Thomas J Sitzman Andrew Keith Wills Stu Toms Jonathan R Sandy Jessica L Chee-Williams M’hamed Temkit Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis BMJ Open |
| title | Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis |
| title_full | Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis |
| title_fullStr | Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis |
| title_full_unstemmed | Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis |
| title_short | Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis |
| title_sort | comparison of secondary surgery before and after centralisation of cleft services in the uk a whole island cross sectional analysis |
| url | https://bmjopen.bmj.com/content/15/8/e105396.full |
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